- 作者：Ursula Schl?tzer-Schrehardt ; Bjoern O. Bachmann ; Theofilos Tourtas ; Claus Cursiefen ; Matthias Zenkel ; Kathrin R?ssler ; Friedrich E. Kruse
- 刊名：Ophthalmology
- 出版年：2013
- 出版时间：September, 2013
- 年：2013
- 卷：120
- 期：9
- 页码：1769-1777
- 全文大小：3738 K
Purpose
To assess the reproducibility of manual graft preparation and evaluate the incidence rate and nature of structural anomalies of Descemet's membrane (DM) preventing successful graft preparation in DM endothelial keratoplasty (DMEK).Design
Prospective, single-center, nonrandomized, consecutive case series.
Participants
We analyzed 350 corneoscleral buttons from donors aged 18-95 years stored in Optisol-GS or Dulbecco's modified Eagle's medium and used for DMEK surgery in 343 consecutive patients with Fuchs' endothelial dystrophy or pseudophakic bullous keratopathy.
Methods
Residual endothelial cell-DM complexes obtained after successful DM stripping for DMEK and whole donor corneas obtained after unsuccessful DM stripping were examined by transmission electron microscopy and immunohistochemistry.
Main Outcome Measures
Accuracy of the cleavage plane between DM and corneal stroma and structural abnormalities of the DM-stroma interface.
Results
Uneventful manual separation without any disruption of DM was achieved in 335 of 350 donor corneas (95.7 % ) by use of a previously established bimanual submerged preparation technique. Correspondingly, the peeled DM specimens revealed a regular and smooth cleavage plane exposing the amorphous interfacial matrix on their anterior surface. Although 8 of 350 donor corneas (2.3 % ) showed focal adhesions of DM to the corneal stroma and developed isolated tears during stripping, preparation of the graft could be successfully completed. However, 7 of the 350 donor corneas (2.0 % ) showed extremely strong adhesion and multiple tears of DM, preventing successful preparation of the graft. These specimens revealed either ultrastructural (peg-like interlockings) or biochemical abnormalities (increased staining intensities for adhesive glycoproteins) along the DM-stroma interface.
Conclusions
Using an appropriate technique, manual preparation of grafts for DMEK with reproducible tissue qualities is possible in the vast majority (98 % ) of donor corneas. Although a relatively rare phenomenon, interindividual variations in DM structure and composition may be responsible for failure of graft preparation in about 2 % of donor corneas.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any of the materials discussed in this article.