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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. 1Department of Ophthalmology, Sorocaba Eye Hospital, Sorocaba, São Paulo, Brazil
  2. 2Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
  3. 3Eye Clinic, São Paulo, São Paulo, Brazil
  4. 4Academic 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

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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.

  • Patient consent for publication Not required.

  • Ethics approval Approval by the BOS Ethics Committee, (number 68647917.5.0000.0088).

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

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

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