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Pre-Descemet’s endothelial keratoplasty: a simple, Descemet’s membrane scoring technique for successful graft preparation
  1. Nicolas Cesario Pereira1,2,
  2. Adriana dos Santos Forseto1,3,
  3. Rafaela Cesario Pereira Maluf1,
  4. Harminder Singh Dua4
  1. 1 Department of Ophthalmology, Sorocaba Eye Hospital, Sorocaba, São Paulo, Brazil
  2. 2 Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
  3. 3 Eye Clinic, São Paulo, São Paulo, Brazil
  4. 4 Academic Section of Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, Nottinghamshire, UK
  1. Correspondence to Dr Nicolas Cesario Pereira, Department of Ophthalmology, Sorocaba Eye Hospital, Sorocaba, Brazil; nicolascepe{at}


Purpose Pre-Descemet’s endothelial keratoplasty (PDEK) donor tissue preparation involves the intrastromal injection of air to create a type 1 big bubble (BB) and avoidance of the creation of a type 2 BB. The purpose of this study was to design and test a technique to consistently creates a type 1 BB without risk of creating a type 2 BB.

Methods A prospective matched study with 64 human donor sclerocorneal discs, which were not suitable for corneal transplantation, was conducted. The corneas were divided into two groups, of which 32 were subjected to the standard technique of preparing the PDEK donor tissue (group 1, control) and 32 new technique, where in the donor Descemet’s membrane was scored with a Sinskey hook. Frequency of occurrence of different types of BB was compared and statistically analysed.

Results With the standard technique (group 1), type 1 BB occurred in 53.1%, type 2 BB in 34.4% and mixed BB in 12.5% of samples. With the scoring technique (group 2), a type 1 BB occurred in 100% of the samples. No type 2 or mixed BB occurred in any case in group 2. The difference in creation of a type 1BB between the two groups was statistically significant (p=0.00).

Conclusion The scoring technique is a simple, inexpensive and reproducible option to consistently achieve a type 1 BB to prepare PDEK graft tissue. The next step would be to study the clinical outcomes of PDEK performed with tissue obtained by the scoring technique.

  • cornea

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests HSD is consultant to Artic Vision, Dompe, Electrospinning, Santen and has shares in Glaxosmithkline and NuVision biotherapies.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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