Descemet's membrane preparation in eye banks for DMEK

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Abstract

Eventhough Descemet Membrane Endothelial Keratoplasty (DMEK) results in unsurpassed improvement of postoperative visual acuity the complexity of graft preparation in DMEK prevents the wide spread use of this technique. Precut tissue preparation in eye banks for DMEK would make this technique amenable to a larger group of surgeons. Precut preparation of organ cultured corneas was preformed as previously described resulting in incompletely stripped Descemet’s membranes where a small central part was still attached to the corneal stroma. After subsequent culture for up to 5 days the precut grafts were used for DMEK. Visual acuity, central corneal thickness and endothelial cell density were retrospectively analyzed. Stripping was successfully completed in all grafts directly prior to surgery. The average visual acuity (logMAR) improved from 0.47 + 0.11 preoperatively to 0.2 + 0.13 3 months after DMEK. Central preoperative corneal thickness decreased from 632 + 46 μm preoperatively to 471 + 7 μm 3 months after DMEK. Average endothelial cell density was 2326 + 119 cells /mm2 before and 2226 + 150 cells/mm2 3 days after precut preparation (2 days before DMEK). 3 months after DMEK endothelial cell density further decreased to 1519 + 57 cells/mm2. Precut preparation of DMEK tissue, generated by incomplete Descemet stripping, leads to minor endothelial cell loss during subsequent culture and results in a fast visual recovery, only minor additional endothelial cell loss and a rapid decrease of corneal thickness.

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