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Appropriate stage of Descemet membrane removal during donor preparation in deep anterior lamellar keratoplasty

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Abstract

Purpose

To investigate the appropriate surgical stage for Descemet membrane (DM) removal during donor preparation in deep anterior lamellar keratoplasty (DALK).

Methods

This study included 83 corneoscleral buttons that were used for DALK. The donor DM was removed randomly either before (group 1; 43 eyes) or after (group 2; 40 eyes) trephination. The time required for DM removal was recorded, and the geometric properties of cut buttons were evaluated after trephination. The intraoperative video recordings were reviewed to determine if the dissections were performed at the stroma-DM plane as it was intended. The time needed to remove the DM, the rate of correct dissection at the intended stroma-DM plane, and the roundness and precision of the donor cuts were compared between the groups.

Results

The two groups were comparable in donor characteristics, including age, quality of the tissue, and trephination size. Time spent to remove DM was significantly shorter in group 1 (68.9 ± 48.2 s) than group 2 (117.7 ± 52.7 s, P = 0.001). DM stripping was performed incorrectly in 2 corneas (4.7%) in group 1 and in 12 corneas (30%) in group 2 (P = 0.01). No difference was found between the groups in the roundness and precision of donor button cuts.

Conclusions

DM removal before trephination did not detrimentally affect the geometric properties of punched donor tissues. When DM stripping was performed before trephination, the donor tissue was less traumatized and posterior graft surface was more likely to be regular; therefore, it is advisable to remove DM before trephination during donor preparation for DALK.

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Funding

There is no financial or propriety interest in any materials used in this manuscript.

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Authors and Affiliations

  1. Department of Ophthalmology, Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St., Pasdaran Ave., Tehran, 16666, Iran

    Sepehr Feizi & Amir A. Azari

Authors
  1. Sepehr Feizi
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  2. Amir A. Azari
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Correspondence to Sepehr Feizi.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study. In addition, consent for donation was obtained from the next-of-kin or legally authorized representative of donors.

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Feizi, S., Azari, A.A. Appropriate stage of Descemet membrane removal during donor preparation in deep anterior lamellar keratoplasty. Int Ophthalmol 40, 1825–1830 (2020). https://doi.org/10.1007/s10792-020-01352-1

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  • DOI: https://doi.org/10.1007/s10792-020-01352-1

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