Original article
Preliminary Clinical Results of Descemet Membrane Endothelial Keratoplasty

https://doi.org/10.1016/j.ajo.2007.09.021Get rights and content

Purpose

To describe the preliminary clinical results of selective transplantation of organ cultured, donor Descemet membrane (DM) carrying autologous corneal endothelium through a 3.5-mm incision, tentatively named Descemet membrane endothelial keratoplasty (DMEK), for the management of corneal endothelial disorders.

Design

Nonrandomized clinical study.

Methods

In 10 patients with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy, DMEK was performed. A 3.5-mm clear corneal tunnel incision was made, the anterior chamber was filled with air, and DM was stripped off from the posterior stroma. A 9.0-mm diameter DM roll was harvested from an organ cultured donor corneo-scleral rim, and inserted into a recipient anterior chamber. The donor tissue was gently unfolded, positioned onto the posterior stroma, and secured by completely filling the anterior chamber with air for 30 minutes.

Results

At one month, six eyes had a best-corrected visual acuity of 0.5 (20/40) or better, and three eyes reached 1.0 (20/20). At six months, the endothelial cell density averaged 2030 (±373) cells/mm2 (n = 7). Three eyes showed a complete detachment of the donor tissue in the early postoperative course that was managed by removal of the transplant and a secondary Descemet stripping endothelial keratoplasty procedure.

Conclusion

DMEK may have potential to become the most preferable technique to manage corneal endothelial disorders, because it provides quick and nearly complete visual rehabilitation. Because the donor tissue required can be prepared from organ cultured corneo-scleral rims, the procedure may be readily accessable to most corneal surgeons.

Section snippets

Methods

The DMEK was performed in four male and six female patients, 45 to 87 years of age, with Fuchs endothelial dystrophy (Table).

Results

In three eyes the implantation of the donor DM was traumatic attributable to complicated donor tissue insertion, vitreous pressure, and incomplete unfolding of the tissue (Cases 2, 4, and 10, respectively; Table). In Case 2, the graft was inadvertently positioned halfway within the tunnel incision, due to reflux of fluid from the anterior chamber immediately after the injection of the tissue. In Case 4, the anterior chamber showed a strong tendency to collapse throughout the procedure. Although

Discussion

In 1998, we reported that transplantation of DM was technically feasible in a human cadaver eye model.11, 12 At that time however, harvesting DM from a donor corneo-scleral rim was considered too challenging in the absence of supporting eyebank facilities. Because stripping DM may sometimes be complicated by inadvertent tearing of the membrane, the surgical preparation of a donor DM sheet may preferably be performed in an eyebank prior to the surgery rather than as a part of the surgical

Gerrit R. J. Melles, MD, PhD, attended medical school and interned at the University of Leyden, The Netherlands, and did his Ophthalmology residency at the University of Nijmegen, The Netherlands. He completed a Research fellowship in San Diego with Perry S. Binder, MD, who also supervised his PhD dissertation. Dr Melles is currently director of the Netherlands Institute of Innovative Ocular Surgery (www.niios.com), and head of Amnitrans Eyebank, in Rotterdam, The Netherlands.

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    Gerrit R. J. Melles, MD, PhD, attended medical school and interned at the University of Leyden, The Netherlands, and did his Ophthalmology residency at the University of Nijmegen, The Netherlands. He completed a Research fellowship in San Diego with Perry S. Binder, MD, who also supervised his PhD dissertation. Dr Melles is currently director of the Netherlands Institute of Innovative Ocular Surgery (www.niios.com), and head of Amnitrans Eyebank, in Rotterdam, The Netherlands.

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