Keratoplasty technique based on organ-cultured Descemet's transplantation shows promise

BARCELONA — Descemet's membrane endothelial keratoplasty may have potential for becoming one of the best techniques for managing corneal endothelial disorders, according to a surgeon speaking here.

"The technique is based on the selective transplantation of an organ-cultured donor Descemet's membrane," Lisanne Ham, MD, said at the European Society of Cataract and Refractive Surgeons Winter Refractive Surgery Meeting.

Dr. Ham reported preliminary clinical results for 10 patients with Fuchs' endothelial dystrophy or pseudophakic bullous keratopathy treated with Descemet's membrane endothelial keratoplasty.

The procedure involves creating a 3.5-mm clear corneal tunnel incision. Next, the anterior chamber is filled with air, and Descemet's membrane is stripped from the posterior stroma.

"We then inserted a 9-mm diameter Descemet's membrane roll, harvested from an organ-cultured donor corneoscleral rim. The donor tissue was gently unfolded, positioned onto the posterior stroma and secured by filling the anterior chamber with air for 30 minutes," Dr. Ham said.

Results were encouraging, she said. At 1 month, six eyes had a best corrected visual acuity of 20/40 or better, and three eyes achieved 20/20. At 6 months follow-up, endothelial cell density averaged 2,030 cells/mm².

The transplantation was unsuccessful in three cases, she said.

"A complete detachment of the donor tissue occurred in the early postoperative period, but it was easy to remove the graft and perform a secondary Descemet's stripping endothelial keratoplasty procedure," Dr. Ham said.

She said she believes the technique holds great potential because it provides quick and nearly complete visual rehabilitation. In addition, because the donor membrane can be obtained from organ-cultured corneoscleral rims, the procedure may be readily accessible to most corneal surgeons, she noted.