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- Fuchs endothelial dystrophy
- Descemet membrane endothelial keratoplasty (DMEK)
- corneal transplantation
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
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