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Am J Ophthalmol. 2012 Aug;154(2):290-296.e1. doi: 10.1016/j.ajo.2012.02.032. Epub 2012 May 23.

Recipient endothelium may relate to corneal clearance in descemet membrane endothelial transfer.

Author information

1
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.

Abstract

PURPOSE:

To describe corneal clearance after re-endothelialization of the recipient posterior stroma through Descemet membrane endothelial transfer (DMET) (ie, a "free-floating" donor Descemet graft in the recipient anterior chamber after descemetorhexis), in managing corneal endothelial disorders.

DESIGN:

Nonrandomized prospective study at a tertiary referral center.

METHODS:

Twelve eyes enrolled in our study, 7 suffering from Fuchs endothelial dystrophy and 5 with bullous keratopathy. The clinical outcome was monitored by biomicroscopy, optical coherence tomography, confocal microscopy, endothelial cell density, and pachymetry measurements.

RESULTS:

All eyes operated on for Fuchs endothelial dystrophy showed corneal clearance, with pachymetry values returning to normal (533 ±47 μm). The denuded recipient stroma re-endothelialized with an average endothelial cell density of 797 (± 743) cells/mm(2) at 6 months after surgery. In contrast, none of the bullous keratopathy eyes showed any improvement throughout the follow-up period.

CONCLUSION:

DMET may be effective in the management of Fuchs endothelial dystrophy (primarily a Descemet membrane disorder), but not in bullous keratopathy (primarily an endothelial depletion). Apparently, the indication for surgery (ie, a "dystrophy" vs a "depletion" of recipient endothelial cells) relates to the capacity of the cornea to clear. This suggests that the remaining rim of recipient endothelium (after descemetorhexis) is involved in the re-endothelialization of the recipient posterior stroma after DMET.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00521898.

PMID:
22633346
DOI:
10.1016/j.ajo.2012.02.032
[Indexed for MEDLINE]

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