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Conventional endothelial keratoplasty (EK) entails stripping off the Descemet's membrane (DM) and transplantation of the posterior lamellar graft. However, isolated cases published in the literature support the feasibility of EK without stripping the DM in patients with failed grafts.1 2 Based on our observation of favourable outcomes after EK without stripping the DM in patients with no clinical evidence of DM pathology, we hypothesise that Descemet's stripping may be an avoidable intraoperative step in EK for the indications where it is expected to be normal and optically clear.
We report our clinical observations in four patients who underwent EK without DM removal for indications other than failed grafts.
Materials and methods
Four cases where EK was performed without DM stripping are described (table 1). DM removal was deferred in these eyes as there were no clinical features suggestive of altered/pathological DM based on slit-lamp examination and intraoperative evaluation.
The donor graft dissection was done using the Moria microkeratome (Moria/Microtek Inc., Doylestown, Pennsylvania, USA). A 4–5 mm scleral or limbal incision was made and the posterior lamellar graft was inserted using sheets of intraocular lens (IOL) glide …