Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany.
Ophthalmology. 2013 Sep;120(9):1769-77. doi: 10.1016/j.ophtha.2013.06.038. Epub 2013 Jul 16.
To assess the reproducibility of manual graft preparation and evaluate the incidence rate and nature of structural anomalies of Descemet's membrane (DM) preventing successful graft preparation in DM endothelial keratoplasty (DMEK).
Prospective, single-center, nonrandomized, consecutive case series.
We analyzed 350 corneoscleral buttons from donors aged 18-95 years stored in Optisol-GS or Dulbecco's modified Eagle's medium and used for DMEK surgery in 343 consecutive patients with Fuchs' endothelial dystrophy or pseudophakic bullous keratopathy.
Residual endothelial cell-DM complexes obtained after successful DM stripping for DMEK and whole donor corneas obtained after unsuccessful DM stripping were examined by transmission electron microscopy and immunohistochemistry.
Accuracy of the cleavage plane between DM and corneal stroma and structural abnormalities of the DM-stroma interface.
Uneventful manual separation without any disruption of DM was achieved in 335 of 350 donor corneas (95.7%) by use of a previously established bimanual submerged preparation technique. Correspondingly, the peeled DM specimens revealed a regular and smooth cleavage plane exposing the amorphous interfacial matrix on their anterior surface. Although 8 of 350 donor corneas (2.3%) showed focal adhesions of DM to the corneal stroma and developed isolated tears during stripping, preparation of the graft could be successfully completed. However, 7 of the 350 donor corneas (2.0%) showed extremely strong adhesion and multiple tears of DM, preventing successful preparation of the graft. These specimens revealed either ultrastructural (peg-like interlockings) or biochemical abnormalities (increased staining intensities for adhesive glycoproteins) along the DM-stroma interface.
Using an appropriate technique, manual preparation of grafts for DMEK with reproducible tissue qualities is possible in the vast majority (98%) of donor corneas. Although a relatively rare phenomenon, interindividual variations in DM structure and composition may be responsible for failure of graft preparation in about 2% of donor corneas.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
评估手动移植物制备的可重复性，并评估在 Descemet 膜（DM）内皮角膜移植术（DMEK）中，防止成功移植物制备的 DM 的结构异常的发生率和性质。
前瞻性、单中心、非随机、连续病例系列。
我们分析了 350 个来自 18-95 岁供体的角膜 - 巩膜瓣，这些供体储存在 Optisol-GS 或 Dulbecco 的改良 Eagle 培养基中，并在 343 例连续患有 Fuchs 内皮营养不良或假性晶状体泡性角膜病变的患者中用于 DMEK 手术。
通过透射电子显微镜和免疫组织化学检查，在成功进行 DMEK 剥离后的残余内皮细胞-DM 复合物和不成功剥离后的整个供体角膜中进行检查。
DM 与角膜基质之间的切割平面的准确性和 DM-基质界面的结构异常。
通过使用先前建立的双手浸没制备技术，在 350 个供体角膜中的 335 个（95.7%）中实现了无干扰的手动分离，而没有任何 DM 中断。相应地，剥离的 DM 标本显示出规则且光滑的切割平面，在前表面暴露无定形的界面基质。尽管 350 个供体角膜中有 8 个（2.3%）显示 DM 与角膜基质的局灶性粘连，并在剥离过程中发生孤立性撕裂，但仍可成功完成移植物的制备。然而，在 350 个供体角膜中有 7 个（2.0%）显示出极强的粘连和 DM 的多处撕裂，阻止了移植物的成功制备。这些标本在 DM-基质界面处显示出超微结构（钉状互锁）或生化异常（黏附糖蛋白的染色强度增加）。
使用适当的技术，对于 DMEK，供体角膜中绝大多数（98%）可实现重复性好的组织质量的移植物制备。尽管这是一种相对罕见的现象，但 DM 结构和组成的个体间差异可能导致约 2%的供体角膜中移植物制备失败。
作者在本文讨论的任何材料中均没有专有或商业利益。
