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Incomplete endothelial graft attachment may still lead to clear cornea, good vision
 Jack Parker |
PRAGUE — An analysis of 44 cases of incomplete endothelial graft attachment gave surprising insights on the biological processes that make the cornea clear after Descemet's membrane endothelial keratoplasty.
"Areas that were uncovered by the graft were perfectly clear, which might show that endothelial cell migration rather than the graft itself is the key mechanism that makes the procedure work," Jack Parker, MD, said at the winter meeting of the European Society of Cataract and Refractive Surgeons.
In seven cases of decentered grafts, the area of bare, uncovered stroma was as clear as the rest of the cornea. Best corrected visual acuity was 20/25 or better. In 23 cases of detached grafts, seven of them with more than 30% detachment, the cornea was still clear and BCVA was 20/40 or better. In three cases of upside-down grafts, mostly detached, the cornea was clear except where the graft was attached to the stroma.
"On the segments of bare stroma, endothelial cells were present and visible with the microscope. How do they get there? They migrate either out from the donor cornea or in from the recipient itself in response to the presence of the graft ," Dr. Parker said.
In three eyes in which the graft was detached completely and free floating in the chamber, a cloudy edematous cornea was found, with no indication of being clear.
"This demonstrates that the physical contact of the graft is mandatory," Dr. Parker said.
- Disclosure: Dr. Parker has no relevant financial disclosures.