Rieck P W, Engels T
Abt. für Augenheilkunde, Schlosspark-Klinik, Heubnerweg 2, 14059, Berlin, Deutschland.
Ophthalmologe. 2017 Aug;114(8):728-733. doi: 10.1007/s00347-016-0395-5.
Descemet membrane endothelial keratoplasty (DMEK) is becoming more and more the method of choice to treat corneal endothelial diseases in specialized centers. The reasons that prevent this technique from becoming widespread are the delicate donor tissue preparation. By inverting the curvature of the cornea from convex to concave after mounting onto an artificial anterior chamber, we developed a combined manual delamination and hydrodissection technique, which allows a rapid and endothelium-preserving method of separating donor Descemet membranes from the underlying stroma.
Experiments were perfomed with 60 donor corneas that were not suitable for transplantation. Donor age ranged between 42 and 94 years. Two experimental groups were formed: 1 inverse manual delamination (n = 16) and 2 combined manual delamination and hydrodissection (n = 44). All experiments were undertaken by an experienced surgeon who was, however, not experienced with these techniques. We examined the frequency of Descemet membrane rupture as well as the amount of induced endothelial damage (trypan blue staining with quantitative image analysis).
Significant lesions of Descemet's membrane that would have led to a loss of the graft occurred in 25% of the manual delamination cases and in 4.5% using the combined technique. Endothelial damage induced by both techniques was low (6 and 5.2%, respectively).
For DMEK donor preparation, a combination of manual delamination and hydrodissection was shown to be a safe and endothelium-protective technique to separate Descemet membranes from the underlying stroma. A very rapid learning curve for the combination technique is of specific additional interest for beginners in DMEK surgery.
在专业中心，Descemet膜内皮角膜移植术（DMEK）越来越成为治疗角膜内皮疾病的首选方法。阻碍该技术广泛应用的原因是供体组织制备精细。通过将角膜安装到人工前房后将其曲率从凸面变为凹面，我们开发了一种手动分层和水分离联合技术，该技术可实现一种快速且能保留内皮的方法，将供体Descemet膜与下方基质分离。
使用60只不适合移植的供体角膜进行实验。供体年龄在42岁至94岁之间。形成了两个实验组：1组为反向手动分层（n = 16），2组为手动分层和水分离联合（n = 44）。所有实验均由一位经验丰富的外科医生进行，但他对这些技术并不熟悉。我们检查了Descemet膜破裂的频率以及诱导的内皮损伤量（用定量图像分析进行台盼蓝染色）。
在手动分层病例中，25%出现了会导致移植物丢失的Descemet膜严重损伤，而使用联合技术的这一比例为4.5%。两种技术诱导的内皮损伤都很低（分别为6%和5.2%）。
对于DMEK供体制备，手动分层和水分离联合技术被证明是一种安全且能保护内皮的技术，可将Descemet膜与下方基质分离。对于DMEK手术初学者而言，该联合技术非常快速的学习曲线具有特别的额外吸引力。
