*Bennett and Bloom Eye Centers, Louisville, KY; †Price Vision Group, Indianapolis, IN; and ‡Cornea Research Foundation of America, Indianapolis, IN.
Cornea. 2014 Mar;33(3):319-25. doi: 10.1097/ICO.0000000000000045.
The aim of this study was to describe the challenges in Descemet membrane endothelial keratoplasty (DMEK) donor preparations and provide new strategies to achieve success.
A series of 263 consecutive DMEK preparation attempts by a novice surgeon during a corneal fellowship are described. In all cases, the Descemet membrane (DM) and the endothelium were peeled off from the donor cornea while it was submerged in corneal storage medium.
The success rate of preparing DMEK tissue was 99%. Three donor preparations of 263 (1.1%) could not be completed successfully because spots of strong adherence between the DM and the stroma caused multiple horseshoe-shaped tears (HST) to form in the DM. Lamellar splitting of the DM ("partial thickness HST") preceded the formation of most HSTs. At least 1 HST occurred in 13% of donor preparations. In donor pairs (right and left corneas of 1 individual donor), if 1 cornea had any HSTs, there was a 60% chance that the contralateral cornea would have at least 1 HST. If 1 cornea had multiple HSTs, there was an 80% chance that the contralateral cornea would have at least 1 HST. Noting this trend, 3 donor corneas were returned to the eye bank unopened for other uses after their mates had multiple HSTs.
With appropriate techniques, DMEK donor preparation can be highly successful, even for a novice surgeon. When a donor develops multiple HSTs, we recommend not using the mate for DMEK because of a higher risk of encountering a preparation difficulty.
本研究旨在描述 Descemet 膜内皮角膜移植术（DMEK）供体准备过程中的挑战，并提供新的策略以获得成功。
描述了一位角膜住院医师在角膜住院医师期间由一位新手外科医生进行的 263 例连续 DMEK 准备尝试。在所有情况下，将供体角膜浸泡在角膜储存液中时，将 Descemet 膜（DM）和内皮从供体角膜上剥离下来。
DMEK 组织制备的成功率为 99%。由于 DM 与基质之间存在强烈的粘连点，导致在 DM 中形成多个马蹄形撕裂（HST），因此 263 例中的 3 例供体准备无法成功完成。DM 的板层分裂（“部分厚度 HST”）先于大多数 HST 的形成。在 13%的供体准备中至少发生了 1 个 HST。在供体对（来自 1 位供体的右眼和左眼）中，如果 1 只角膜有任何 HST，则对侧角膜至少有 1 个 HST 的可能性为 60%。如果 1 只角膜有多个 HST，则对侧角膜至少有 1 个 HST 的可能性为 80%。注意到这一趋势，在 3 只供体角膜的对侧角膜出现多个 HST 后，它们被退回眼库，未打开用于其他用途。
即使对于新手外科医生，使用适当的技术，DMEK 供体准备也可以非常成功。当供体出现多个 HST 时，我们建议不要将其配对用于 DMEK，因为遇到准备困难的风险较高。
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