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Incidence of recipient Descemet membrane remnants at the donor-to-stromal interface after descemetorhexis in endothelial keratoplasty
  1. Isabel Dapena1,2,
  2. Lisanne Ham1,2,
  3. Kyros Moutsouris1,2,
  4. Gerrit R J Melles1,2,3
  1. 1Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
  2. 2Melles Cornea Clinic, Rotterdam, The Netherlands
  3. 3Amnitrans EyeBank, Rotterdam, The Netherlands
  1. Correspondence to Dr Gerrit R J Melles, Netherlands Institute for Innovative Ocular Surgery, Laan op Zuid 88, 3071 AA Rotterdam, The Netherlands; melles{at}

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In 2004, our group described a descemetorhexis to enable Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK) and Descemet membrane endothelial keratoplasty (DMEK).1 Removal of the recipient Descemet membrane (DM) may be an important step in endothelial keratoplasty, because the procedures are predominantly performed for Fuchs endothelial dystrophy, a corneal disorder characterised by guttatae, that is, collagenous Hassall–Henle warts in DM. Since these guttatae themselves may cause reduced visual acuity, incomplete removal of the pathological DM may compromise the optical performance of the cornea after transplantation.1

Recently, we observed two eyes that showed guttata-like abnormalities after DMEK (figure 1), suggesting that large areas of recipient DM remained in situ despite the performance of a ‘complete’ descemetorhexis during surgery. This finding could relate to the anatomy of DM (ie, a separation of the posterior (postnatal) DM from the anterior (prenatal) DM) or to observations in pathology specimens, in which diseased DM in Fuchs endothelial dystrophy showed a multiple layered structure.2

Figure 1

Images displaying a large central island of recipient Descemet membrane after Descemet membrane endothelial keratoplasty (DMEK), despite its supposedly ‘complete’ …

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  • Competing interests GRJM is a consultant for D.O.R.C./Dutch Ophthalmic USA. The remaining authors declare no potential conflict of interest.

  • Patient consent Obtained.

  • Ethics approval This study was conducted in compliance with the Institutional Review Board and Informed Consent requirements, in adherence to the tenets of the Declaration of Helsinki, at The Netherlands Institute for Innovative Ocular Surgery (Study registration no N.05.14).

  • Trial registration number NCT00521898

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