Technique for preparation of the corneal endothelium-Descemet membrane complex for transplantation

• Published in: Cornea Vol. 25; no. 6; p. 705
• Main Authors: Zhu, Zejin, Rife, Lawrence, Yiu, Samuel, Trousdale, Melvin D, Wasilewski, Daniel, Siqueira, Alexandre, Smith, Ronald E
• Format: Journal Article
• Language: English
• Published: United States 01.07.2006
• Subjects: Adult; Aged; Anthraquinones; Corneal Transplantation; Descemet Membrane; Endothelium, Corneal - pathology; Endothelium, Corneal - transplantation; Female; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Organ Preservation; Staining and Labeling - methods; Tissue and Organ Harvesting - methods
• DOI: 10.1097/01.ico.0000214229.21238.eb
• ISSN: 0277-3740

Replacing diseased corneal endothelium with a preparation of Descemet membrane carrying functional endothelium and no stroma may be a feasible method for treating corneal endothelial decompensation. To obtain a viable donor of a Descemet membrane endothelium disc, we modified the Descemet membrane stripping technique and monitored the percentage of endothelial damage to the donor tissue preparation. Forty-eight human corneas were used. Cornea buttons were mounted on an artificial anterior chamber, endothelial side up. Endothelia were stained with alizarin red, examined under the microscope, and photographed at 5 different sites (microscope, x100; digital magnification, x2.83). A 6 x 7-mm rectangular piece of endothelium-Descemet membrane complex was obtained using a Grieshaber microsurgical knife and Kelman-McPherson forceps. Digital photographs of endothelia were analyzed with a computer, and the percentage of endothelial damage was calculated. Specimens were processed for hematoxylin-eosin staining. Forty of 48 endothelium-Descemet membrane preparations (83.3%) were complete peels with minimal endothelial damage. Endothelial damage before and after the surgery was 1.57 +/- 2.11% and 2.61 +/- 1.77%, respectively. Eight preparations (16.7%) failed because of tearing. Multiple hematoxylin-eosin-stained sections showed the presence of endothelium with intact Descemet membrane and no stromal tissue. We modified the technique of Melles and obtained a sheet of Descemet membrane and endothelium with minimal endothelial damage and with no remaining stroma observed. This simple technique can be used to obtain the endothelium-Descemet membrane complex in minutes. It may be useful for corneal endothelium transplantation.