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New microkeratome allows for safer preparation of ultrathin endothelial grafts
AMSTERDAM — Innovative microkeratome technology allows for single-pass ultrathin (<100μ) dissection of endothelial grafts, with low endothelial cell loss, according to one speaker.
“Descemet membrane endothelial keratoplasy (DMEK) allows for faster visual rehabilitation and better outcomes compared with other techniques, but has not gained widespread use,” Mor Dickman, MD, said at the Eucornea meeting here.
The steep learning curve and the high incidence of graft dislocation are main reasons, but difficulties with preparation of the thin endothelial graft and concerns about endothelial cell loss in manipulating the tissue also play a role.
Mor Dickman
Multiple techniques for donor preparation have been developed to limit tissue damage and manipulation, Dickman said. Microkeratomes have not been considered adequate to produce grafts of predictable thickness and regular profile. In addition, it is unclear how endothelial cells may react to forces during mechanical harvesting.
The newly designed Gebauer SLc Expert microkeratome has specific features for harvesting pre-descemetic corneal lamellae, Dickman said.
“Using the porous rigid reference membrane, vacuum based corneal applanation can be achieved , allowing dissection of any desired thickness between 30 and 950µ. It also allows correction for peripheral to center corneal thickness differences, eliminating the meniscus-shaped profile characteristic of classical microkeratome dissection,” he said.
EndotheliaI cell density was assessed by light microscopy in 22 paired donor corneas following the use of the new microkeratome, equipped with a 400, 450, 500 or 550μ head, aiming at a residual thickness of 100μ. Single pass ultrathin graft preparation was not associated with a significant endothelial cell density loss.
Disclosure: Dickman has no relevant financial disclosures.