Splitting of the Recipient's Descemet Membrane in Descemet Membrane Endothelial Keratoplasty—Ultrastructure and Clinical Relevance

详细信息    查看全文

• 作者：Julia M. Weller ; ^{julia.weller@uk-erlangen.de" class="auth_mail" title="E-mail the corresponding author} ; Ursula Schlö ; tzer-Schrehardt ; Friedrich E. Kruse ; Theofilos Tourtas
• 刊名：American Journal of Ophthalmology
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：172
• 期：Complete
• 页码：1-6
• 全文大小：1299 K

文摘

In Descemet membrane endothelial keratoplasty (DMEK), lamellar splitting of the Descemet membrane (DM) may occur during stripping of host DM, leaving residual DM on the recipient's DMEK interface. The purpose of this study was to determine the incidence rate of lamellar splitting of DM during DMEK and to describe the ultrastructure of DM in these eyes.

Design

Retrospective consecutive case series.

Methods

setting: Institutional, single-center. patient population: Total of 664 eyes with Fuchs endothelial corneal dystrophy (FECD) scheduled for primary DMEK. intervention: DMEK. main outcome measures: The incidence rate of lamellar DM splitting in the recipients' eyes; ultrastructural alterations of stripped DM specimens (transmission electron microscopy); preoperative best-corrected visual acuity (BCVA), central corneal thickness (CCT), and prevalence of diabetes mellitus.

Results

Sixty-three of 664 eyes (9.5%) with FECD showed lamellar splitting of DM resulting in the dissociation of 2 separate layers. Transmission electron microscopy revealed accumulations of banded and wide-spaced collagen between the thicker posterior banded layer and the thin anterior banded layer, which is adhesive to the corneal stroma. Lamellar splitting occurred along these abnormal collagen inclusions, demarcating the borderline between both layers of DM.

Conclusions

Lamellar DM splitting occurs during DM stripping in almost 10% of eyes with FECD. This phenomenon appears to be caused by abnormal collagenous material deposits at the borderline between anterior and posterior layers of DM.