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Br J Ophthalmol 94:909-914 doi:10.1136/bjo.2009.165134
  • Clinical science

Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S)

  1. Katerina Jirsova3,4
  1. 1Department of Ophthalmology, Sokolov Hospital, Sokolov, Czech Republic
  2. 2Department of Ophthalmology, Teaching Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
  3. 3Laboratory of the Biology and Pathology of the Eye, Institute of Inherited Metabolic Disorders, General Teaching Hospital, Charles University, Prague, Czech Republic
  4. 4Ocular Tissue Bank, General Teaching Hospital, Prague, Czech Republic
  1. Correspondence to Dr Pavel Studeny, Department of Ophthalmology, Sokolov Hospital, 35601 Sokolov, Czech Republic; studenypavel{at}seznam.cz
  • Accepted 3 October 2009
  • Published Online First 22 October 2009

Abstract

Aim To describe a novel technique for the preparation and transplantation of posterior corneal lamellae consisting of endothelium and bare Descemet membrane with a stromal supporting rim.

Methods Posterior lamellar discs for Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S) were prepared manually immediately before surgery using the big bubble technique. The retrospective case series that underwent DMEK-S comprised 20 eyes of 18 patients with endothelial dysfunction. Best-corrected visual acuity (BCVA) and endothelial cell density (ECD) were measured preoperatively and 12–24 months after DMEK-S.

Results At the end of the follow-up, 10 out of 18 eyes achieved a BCVA of 1.0 or better, and 17 reached 0.5 or better. Primary graft failure occurred in two eyes. The average ECD at 1 year was 1608 (±503) cells/mm2, that is, a mean cell loss from preoperative values of 44%. Partial early postoperative graft detachment (12 of 20 eyes) was treated by injecting an air bubble into the anterior chamber in all cases. The loss of donor corneas during preparation decreased from approximately 10 to 5% as more experience was acquired with the procedure.

Conclusions Preliminary outcomes show that DMEK-S may be used in the treatment of corneal endothelial dysfunction. As this approach is entirely manual, and no special surgical equipment is needed, it has the potential to become widely adopted.

Footnotes

  • Funding This work was supported by the Czech Ministry of Education, Youth and Sports research project 0021620806/20610011.

  • Competing interests None.

  • Ethics approval The study was approved by the Ethics Committee of Karlovy Vary District Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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