Reproducibility of graft preparations in Descemet's membrane endothelial keratoplasty
Schlötzer-Schrehardt U, Bachmann B, Tourtas T, Cursiefen C, Zenkel M, Roessler K, Kruse F (2013)
Publication Type: Journal article
Publication year: 2013
Journal
Book Volume: 120
Pages Range: 1769-77
Journal Issue: 9
DOI: 10.1016/j.ophtha.2013.06.038
Abstract
To assess the reproducibility of manual graft preparation and evaluate the incidence rate and nature of structural anomalies of Descemet's membrane (DM) preventing successful graft preparation in DM endothelial keratoplasty (DMEK).Prospective, single-center, nonrandomized, consecutive case series.We analyzed 350 corneoscleral buttons from donors aged 18-95 years stored in Optisol-GS or Dulbecco's modified Eagle's medium and used for DMEK surgery in 343 consecutive patients with Fuchs' endothelial dystrophy or pseudophakic bullous keratopathy.Residual endothelial cell-DM complexes obtained after successful DM stripping for DMEK and whole donor corneas obtained after unsuccessful DM stripping were examined by transmission electron microscopy and immunohistochemistry.Accuracy of the cleavage plane between DM and corneal stroma and structural abnormalities of the DM-stroma interface.Uneventful manual separation without any disruption of DM was achieved in 335 of 350 donor corneas (95.7%) by use of a previously established bimanual submerged preparation technique. Correspondingly, the peeled DM specimens revealed a regular and smooth cleavage plane exposing the amorphous interfacial matrix on their anterior surface. Although 8 of 350 donor corneas (2.3%) showed focal adhesions of DM to the corneal stroma and developed isolated tears during stripping, preparation of the graft could be successfully completed. However, 7 of the 350 donor corneas (2.0%) showed extremely strong adhesion and multiple tears of DM, preventing successful preparation of the graft. These specimens revealed either ultrastructural (peg-like interlockings) or biochemical abnormalities (increased staining intensities for adhesive glycoproteins) along the DM-stroma interface.Using an appropriate technique, manual preparation of grafts for DMEK with reproducible tissue qualities is possible in the vast majority (98%) of donor corneas. Although a relatively rare phenomenon, interindividual variations in DM structure and composition may be responsible for failure of graft preparation in about 2% of donor corneas.The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Authors with CRIS profile
Ursula Schlötzer-Schrehardt
Medizinische Fakultät
Matthias Zenkel
Department of Ophthalmology
Friedrich Kruse
Lehrstuhl für Augenheilkunde
Involved external institutions
Germany (DE)How to cite
APA:
Schlötzer-Schrehardt, U., Bachmann, B., Tourtas, T., Cursiefen, C., Zenkel, M., Roessler, K., & Kruse, F. (2013). Reproducibility of graft preparations in Descemet's membrane endothelial keratoplasty. Ophthalmology, 120(9), 1769-77. https://doi.org/10.1016/j.ophtha.2013.06.038
MLA:
Schlötzer-Schrehardt, Ursula, et al. "Reproducibility of graft preparations in Descemet's membrane endothelial keratoplasty." Ophthalmology 120.9 (2013): 1769-77.
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