Friedrich Maximilian, Lind Jasper, Son Hyeck-Soo, Yildirim Timur Mert, Auffarth Gerd Uwe, Augustin Victor Aristide
Department of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany.
Eye (Lond). 2025 May 27. doi: 10.1038/s41433-025-03872-5.
During Descemetorhexis in Descemet Membrane Endothelial Keratoplasty (DMEK), inadvertent lamellar splitting of the recipient's Descemet membrane (DM) may occur, leaving DM remnants on the posterior corneal surface. This study investigates the influence of lamellar splitting on surgical outcome as well as the histological ultrastructure of split DMs.
In this prospective, observational, single-centre cohort study 129 eyes of 102 patients were divided into two groups depending on the occurrence of intraoperative splitting. If splitting of the recipient's DM occurred, the remnants were polished via irrigation/aspiration. The primary outcome was the corrected distance visual acuity (CDVA) four months after DMEK. Secondary outcomes were central corneal thickness (CCT), thinnest corneal thickness (TCT), posterior corneal density (PCD), endothelial cell loss (ECL), and the re-bubbling rate. For histopathological analysis two removed DMs were examined using scanning and transmission electron microscopy.
Intraoperative splitting occurred in 36 eyes (27.9%). The postoperative CDVA in the group with splitting (0.12 ± 0.12 logMAR) did not significantly differ from the group without splitting (0.12 ± 0.12 logMAR; p = 0.96). CCT, TCT, PCD, ECL, and the re-bubbling rate also did not significantly differ between both groups (p > 0.05). In ultrastructural analysis, the split layer had a thickness of 2 µm and showed an irregular splitting interface.
Inadvertent lamellar splitting of the recipient's DM during DMEK does not have a significant impact on the visual outcome. Therefore, polishing the DM remnants intraoperatively may address this complication in sufficient manner for optimizing visual outcomes.
在Descemet膜内皮角膜移植术（DMEK）中进行后弹力层撕除时，受者的后弹力层（DM）可能会意外发生板层分离，导致DM残余物留在角膜后表面。本研究调查了板层分离对手术结果以及分离的DM组织学超微结构的影响。
在这项前瞻性、观察性、单中心队列研究中，102例患者的129只眼根据术中是否发生分离分为两组。如果受者的DM发生分离，则通过冲洗/抽吸对残余物进行抛光。主要结局是DMEK术后4个月的矫正远视力（CDVA）。次要结局包括中央角膜厚度（CCT）、最薄角膜厚度（TCT）、角膜后表面密度（PCD）、内皮细胞丢失（ECL）和再气泡形成率。为进行组织病理学分析，使用扫描电子显微镜和透射电子显微镜检查了两块切除的DM。
36只眼（27.9%）术中发生分离。发生分离组的术后CDVA（0.12±0.12 logMAR）与未发生分离组（0.12±0.12 logMAR；p = 0.96）无显著差异。两组之间的CCT、TCT、PCD、ECL和再气泡形成率也无显著差异（p>0.05）。在超微结构分析中，分离层厚度为2μm，分离界面不规则。
DMEK术中受者DM的意外板层分离对视觉结果没有显著影响。因此，术中对DM残余物进行抛光可能足以解决这一并发症，从而优化视觉结果。
