Lawrence R Tenkman1, Francis W Price, Marianne O Price. 1. *Bennett and Bloom Eye Centers, Louisville, KY; †Price Vision Group, Indianapolis, IN; and ‡Cornea Research Foundation of America, Indianapolis, IN.
Abstract
PURPOSE: The aim of this study was to describe the challenges in Descemet membrane endothelial keratoplasty (DMEK) donor preparations and provide new strategies to achieve success. METHODS: A series of 263 consecutive DMEK preparation attempts by a novice surgeon during a corneal fellowship are described. In all cases, the Descemet membrane (DM) and the endothelium were peeled off from the donor cornea while it was submerged in corneal storage medium. RESULTS: The success rate of preparing DMEK tissue was 99%. Three donor preparations of 263 (1.1%) could not be completed successfully because spots of strong adherence between the DM and the stroma caused multiple horseshoe-shaped tears (HST) to form in the DM. Lamellar splitting of the DM ("partial thickness HST") preceded the formation of most HSTs. At least 1 HST occurred in 13% of donor preparations. In donor pairs (right and left corneas of 1 individual donor), if 1 cornea had any HSTs, there was a 60% chance that the contralateral cornea would have at least 1 HST. If 1 cornea had multiple HSTs, there was an 80% chance that the contralateral cornea would have at least 1 HST. Noting this trend, 3 donor corneas were returned to the eye bank unopened for other uses after their mates had multiple HSTs. CONCLUSIONS: With appropriate techniques, DMEK donor preparation can be highly successful, even for a novice surgeon. When a donor develops multiple HSTs, we recommend not using the mate for DMEK because of a higher risk of encountering a preparation difficulty.
PURPOSE: The aim of this study was to describe the challenges in Descemet membrane endothelial keratoplasty (DMEK) donor preparations and provide new strategies to achieve success. METHODS: A series of 263 consecutive DMEK preparation attempts by a novice surgeon during a corneal fellowship are described. In all cases, the Descemet membrane (DM) and the endothelium were peeled off from the donor cornea while it was submerged in corneal storage medium. RESULTS: The success rate of preparing DMEK tissue was 99%. Three donor preparations of 263 (1.1%) could not be completed successfully because spots of strong adherence between the DM and the stroma caused multiple horseshoe-shaped tears (HST) to form in the DM. Lamellar splitting of the DM ("partial thickness HST") preceded the formation of most HSTs. At least 1 HST occurred in 13% of donor preparations. In donor pairs (right and left corneas of 1 individual donor), if 1 cornea had any HSTs, there was a 60% chance that the contralateral cornea would have at least 1 HST. If 1 cornea had multiple HSTs, there was an 80% chance that the contralateral cornea would have at least 1 HST. Noting this trend, 3 donor corneas were returned to the eye bank unopened for other uses after their mates had multiple HSTs. CONCLUSIONS: With appropriate techniques, DMEK donor preparation can be highly successful, even for a novice surgeon. When a donor develops multiple HSTs, we recommend not using the mate for DMEK because of a higher risk of encountering a preparation difficulty.
Authors: Lucas M M Vianna; Christopher G Stoeger; Joshua D Galloway; Mark Terry; Leslie Cope; Rubens Belfort; Albert S Jun Journal: Am J Ophthalmol Date: 2015-01-30 Impact factor: 5.258
Authors: Annekatrin Rickmann; Karl Boden; Silke Wahl; Andre Trouvain; Andre Schulz; Peter Szurman Journal: Int Ophthalmol Date: 2021-10-21 Impact factor: 2.031