Original articleSplit Cornea Transplantation for 2 Recipients: A New Strategy to Reduce Corneal Tissue Cost and Shortage
Section snippets
Patients and Methods
Between June and September 2009, 12 consecutive donor corneas were planned for split cornea transplantation at the Department of Ophthalmology, University Eye Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Germany. Of 289 patients waiting for a keratoplasty, 1 consecutive patient with keratoconus suitable for a DALK procedure and 1 consecutive patient with Fuchs' endothelial dystrophy suitable for a DMEK procedure were scheduled for the same surgery day. This was done for a total
Deep Anterior Lamellar Keratoplasty
Twelve keratoconus eyes of 4 women and 8 men (mean age±SD at the time of surgery, 41.5±14.5 years; range, 24–66 years) were scheduled for DALK (Table 1, available at http://aaojournal.org). The mean preoperative BSCVA was 20/131 (range, 20/200–20/63), the spherical equivalent was –3.5±2.7 diopters (D; range, –10.5 to 0.0 D), and the refractive astigmatism was 2.6±2.3 D (range, 0.0–8.5 D). The preoperative central corneal thickness averaged 411±60 μm (range, 326–498 μm), and the endothelial cell
Discussion
Both DALK using the big-bubble technique and DMEK are relatively new surgical techniques. Both lamellar approaches of corneal transplantation theoretically come close to an ideal surgical solution for the respective diseases they are intended to cure. In corneal diseases affecting solely the anterior stroma and not the endothelium–Descemet's membrane layer, such as keratoconus, only the anterior part of the cornea (including epithelium, its basement membrane, Bowman's layer, and stroma) is
References (54)
- et al.
Efficacy of routine notification and request on reducing corneal transplantation wait times in Canada
Can J Ophthalmol
(2009) - et al.
The transplantation law: a chance to overcome the shortage of corneal grafts in Germany?
Transplant Proc
(2002) - et al.
Extended long-term outcomes of penetrating keratoplasty for keratoconus
Ophthalmology
(2006) - et al.
Big-bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty
J Cataract Refract Surg
(2002) - et al.
Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus
Ophthalmology
(2004) - et al.
Descemet's stripping automated endothelial keratoplasty outcomes compared with penetrating keratoplasty from the Cornea Donor Study
Ophthalmology
(2010) - et al.
Comparison of posterior lamellar keratoplasty techniques to penetrating keratoplasty
Ophthalmology
(2008) - et al.
Endothelial cell loss after Descemet stripping with endothelial keratoplasty influencing factors and 2-year trend
Ophthalmology
(2008) - et al.
Descemet's stripping with endothelial keratoplasty: comparative outcomes with microkeratome-dissected and manually dissected donor tissue
Ophthalmology
(2006) - et al.
Endokeratoplasty as an alternative to penetrating keratoplasty for the surgical treatment of diseased endothelium: initial results
Ophthalmology
(2000)
Endothelial keratoplasty for Fuchs' dystrophy with cataract: complications and clinical results with the new triple procedure
Ophthalmology
A prospective study of endothelial cell loss during the 2 years after deep lamellar endothelial keratoplasty
Ophthalmology
Donor tissue preparation for Descemet membrane endothelial keratoplasty
J Cataract Refract Surg
Endothelial cell density after Descemet membrane endothelial keratoplasty: 1- to 2-year follow-up
Am J Ophthalmol
Descemet's membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival
Ophthalmology
In situ split liver transplantation for adult and pediatric recipients: an answer to organ shortage
Transplant Proc
Shortage in the face of plenty: improving the allocation of corneas for transplantation
Dev Ophthalmol
The penetrating keratoplasty: a 100-year success story [in German]
Ophthalmologe
Long-term refractive and visual outcome after penetrating keratoplasty only versus the triple procedure in Fuchs' dystrophy
Graefes Arch Clin Exp Ophthalmol
A new surgical technique for deep stromal, anterior lamellar keratoplasty
Br J Ophthalmol
Deep lamellar keratoplasty: surgical techniques for anterior lamellar keratoplasty with and without baring of Descemet's membrane
Cornea
New techniques in lamellar keratoplasty
Curr Opin Ophthalmol
Simplified technique for deep lamellar keratoplasty [letter]
Cornea
Use of a “small-bubble technique” to increase the success of Anwar's “big-bubble technique” for deep lamellar keratoplasty with complete baring of Descemet's membrane
Br J Ophthalmol
Clinical outcomes after deep anterior lamellar keratoplasty using the big-bubble technique in patients with keratoconus
Am J Ophthalmol
Results of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus
Am J Ophthalmol
Comparison of three different techniques of corneal transplantation for keratoconus
Am J Ophthalmol
Cited by (117)
Approaches for corneal endothelium regenerative medicine
2022, Progress in Retinal and Eye ResearchCorneal endothelial dysfunction: Evolving understanding and treatment options
2021, Progress in Retinal and Eye ResearchCitation Excerpt :The existing donor supply can be extended by dividing a single donor cornea among multiple recipients, for which DMEK is particularly well suited. One way of splitting the tissue is to use the corneal endothelium for DMEK and the stromal tissue for deep anterior lamellar keratoplasty (Heindl et al., 2011). However, the demand for corneal endothelial tissue substantially exceeds the demand for corneal stromal tissue (Eye Bank Association of America, 2020).
Fuchs endothelial corneal dystrophy: The vicious cycle of Fuchs pathogenesis
2021, Progress in Retinal and Eye ResearchOutcome of Descemet Membrane Endothelial Keratoplasty Using Corneas from Donors ≥80 Years of Age
2020, American Journal of OphthalmologyImmune reactions after modern lamellar (DALK, DSAEK, DMEK) versus conventional penetrating corneal transplantation
2019, Progress in Retinal and Eye ResearchFacile fabrication of superporous and biocompatible hydrogel scaffolds for artificial corneal periphery
2019, Colloids and Surfaces B: Biointerfaces
Manuscript no. 2010-135.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported by the Interdisciplinary Center for Clinical Research (IZKF) Erlangen (A9), Erlangen, Germany.