Stromal support for Descemet's membrane endothelial keratoplasty

Ophthalmology. 2010 Dec;117(12):2273-7. doi: 10.1016/j.ophtha.2010.03.038. Epub 2010 Aug 3.


Purpose: To evaluate the use of a peripheral stromal support to facilitate and improve the outcomes of Descemet's membrane endothelial keratoplasty (DMEK).

Design: Prospective case series.

Participants: Ten patients with Fuchs' endothelial dystrophy.

Intervention: Pneumatic dissection was used to detach the central part of the Descemet's membrane and endothelium from the deep stroma. Endothelial grafts including a peripheral stromal support were obtained by eccentric punching of donor tissue and used to perform DMEK surgery in 10 patients.

Main outcome measures: Operative time, graft attachment rate, best spectacle-corrected visual acuity (BSCVA), endothelial cell loss, refraction, and complications.

Results: In all cases the surgical time was ≤ 1 hour. The postoperative course was uneventful in all but 2 cases, which required rebubbling owing to early graft detachment. Final attachment rate was 100%. The average follow-up was 8.4 months (range, 6-12). Postoperative BSCVA was ≥ 20/40 in all cases and no substantial change in refraction was recorded. Postoperative endothelial cell loss averaged 24.1% (range, 8%-34.9%).

Conclusions: Stromal support facilitates surgery, reduces complications, and appears to maintain the favorable outcomes of DMEK.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Corneal Endothelial Cell Loss / diagnosis
  • Corneal Stroma / physiology*
  • Corneal Transplantation / methods*
  • Descemet Membrane / surgery*
  • Endothelium, Corneal / transplantation*
  • Female
  • Follow-Up Studies
  • Fuchs' Endothelial Dystrophy / surgery*
  • Graft Survival
  • Humans
  • Intraoperative Complications
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prospective Studies
  • Refraction, Ocular / physiology
  • Time Factors
  • Visual Acuity / physiology