Simple novel surgical device to facilitate preparation of endothelial grafts for DMEK

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Abstract

Purpose

Descemet’s membrane and endothelial keratoplasty (DMEK) is the only technique to achieve a posterior corneal transplant without any interface. It is however difficult to achieve, mainly during the preparation of the graft. We propose a simple novel surgical device to facilitate this preparation.

Methods

We used 20 corneas for research in this study. The device is in the form of a circular blade with a diameter of 8.5 mm. The blade is broken in two opposite points on 4 mm. The blade is applied to the cornea in order to cut Descemet's membrane and deep stroma. Preparation of the endothelial graft is performed on an artificial anterior chamber using a simple technique with a 27 gauge cannula to detach Descemet’s membrane. The dissection is performed under the microscope by a corneal bank technician in 8 cases, by a resident in 4 cases by a cataract surgeon in 8 cases. The three operators followed a specific course on the same day of dissection but had never tried to dissect a DMEK graft before. Endothelial cell density (ECD) was measured before dissection and 3 days after storage in organ culture. Histological analysis was performed.

Results

Descemet graft could be easily dissected in 19 cases and resident failed dissection in one case. ECD was 2534±275 cells/mm2 before dissection and 2412+/-360 cells/mm2, after 3 days in organ culture (p<0.01). Histological sections confirm that the cleavage was between DM and posterior stroma.

Conclusion

We report here a reliable and efficient technique for the preparation of pure descemetic grafts.

Conclusion

Commercial interest

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