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Descemet’s membrane endothelial keratoplasty with a stromal rim (DMEK-S)
  1. Pavel Studeny1,*,
  2. Andrej Farkas1,
  3. Magdalena Vokrojova2,
  4. Petra Liskova3,
  5. Katerina Jirsova3
  1. 1 Department of Ophthalmology, Sokolov Hospital, Czech Republic;
  2. 2 Department of Ophthalmology, Teaching Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic;
  3. 3 Laboratory of the Biology and Pathology of the Eye, Charles University, Prague, Czech Republic
  1. Correspondence to: , ; studenypavel{at}seznam.cz

Abstract

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

Methods: Posterior lamellar discs for Descemet’s 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 one year was 1608 (± 503) cells/mm2, i.e. 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.

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