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Descemet Membrane Transplantation

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Modern Keratoplasty

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

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Abstract

The growing scarcity of cadaver-based tissue has made us examine alternative technologies. Fuchs’ Endothelial Corneal Dystrophy (FECD) is the leading indication for corneal transplantation. In early FECD, the disease is confined to the central cornea, with the paracentral endothelial cells remaining unaffected. Our previous in vitro/in vivo work has shown that endothelial cell migration was faster on a bare Descemet membrane (DM) than on a bare stroma. Here, we describe a series of patients who have undergone this technique. The surgery involves the stripping of the central 5–5.5 mm guttata and then replacing this defect with a bare DM. The new acellular DM adheres to the stroma using a gas bubble in the anterior chamber. Subsequent endothelial migration from the paracentral cornea will improve central endothelial function. Successful migration is seen in 6 weeks. Rocki supplementation is required in older patients. The key advantages are the lack of need for long steroids and the ability to use non-EK grade tissue, hence increasing tissue utilization.

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Author information

Authors and Affiliations

  1. Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore

    Hon Shing Ong & Jodhbir S. Mehta

  2. Tissue Engineering and Cell Therapy Department, Singapore Eye Research Institute, Singapore, Singapore

    Hon Shing Ong & Jodhbir S. Mehta

  3. Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore

    Hon Shing Ong & Jodhbir S. Mehta

  4. School of Material Science and Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore

    Jodhbir S. Mehta

Authors
  1. Hon Shing Ong
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  2. Jodhbir S. Mehta
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Editor information

Editors and Affiliations

  1. Vissum Miranza, Miguel Hernández University, Alicante, Spain

    Jorge L. Alió

  2. Vissum-Instituto Oftalmologico de Alica, Miguel Hernandez University, Alicante, Alicante, Spain

    Jorge L. Alió del Barrio

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Ong, H.S., Mehta, J.S. (2023). Descemet Membrane Transplantation. In: Alió, J.L., del Barrio, J.L.A. (eds) Modern Keratoplasty. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-031-32408-6_33

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  • DOI: https://doi.org/10.1007/978-3-031-32408-6_33

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-32407-9

  • Online ISBN: 978-3-031-32408-6

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