Optimizing descemet membrane endothelial keratoplasty using intraoperative optical coherence tomography

JAMA Ophthalmol. 2013 Sep;131(9):1135-42. doi: 10.1001/jamaophthalmol.2013.4672.


Importance: Descemet membrane endothelial keratoplasty (DMEK) is a challenging procedure for the surgeon, particularly because of deficient visibility of the delicate tissue due to the natural en face view through the operating microscope. A cross-sectional view would greatly enhance intraoperative overview and enable the surgeon to better control the procedure.

Objective: To retrospectively analyze the use of intraoperative optical coherence tomography (iOCT) for improving the safety of DMEK.

Design: Intraoperative OCT during DMEK was performed in 26 eyes of 26 patients. We retrospectively analyzed imaging and video data.

Setting: Department of Ophthalmology, University of Cologne.

Participants: Seven men and 19 women aged 39 to 93 years with corneal endothelial dysfunction undergoing DMEK.

Exposure: Descemet membrane endothelial keratoplasty.

Main outcomes and measures: Visibility of surgical steps, overall duration of DMEK, overall time for complete intraoperative air filling of the anterior chamber, and correlation between donor age and Descemet rolling behavior. RESULTS Intraoperative OCT enables visualization of all steps of the DMEK procedure. Overall mean (SD) duration of the DMEK procedure was 25.7 (6.9) minutes when using iOCT. Overall mean (SD) complete intraoperative anterior chamber air-filling time was 236 (108) seconds in contrast to 60 to 90 minutes for standard air-filling time. Descemet membrane rolling behavior showed significant inverse correlation between donor age (range, 39-93 years) and the extent of rolling (R2 = 0.5 [P = .006]).

Conclusions and relevance: Intraoperative OCT enhances the visibility of graft orientation and unfolding, thereby improving safety of the DMEK procedure. Overall, iOCT is a helpful device that may support surgeons in all steps of DMEK procedures.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cell Count
  • Corneal Endothelial Cell Loss / diagnosis
  • Corneal Endothelial Cell Loss / surgery*
  • Descemet Membrane / pathology*
  • Descemet Stripping Endothelial Keratoplasty / methods*
  • Diagnostic Techniques, Ophthalmological*
  • Female
  • Graft Survival
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Intraoperative
  • Organ Culture Techniques
  • Retrospective Studies
  • Tissue Donors
  • Tomography, Optical Coherence*