Anatomy‐based DMEK Wetlab in Homburg/Saar: Novel aspects of donor preparation and host maneuvers to teach descemet membrane endothelial keratoplasty

Use of Descemet Membrane Endothelial Keratoplasty (DMEK) has been limited because of problems with donor preparation, i.e. tearing of the Descemet membrane and difficulties in unfolding the Endothelium‐Descemet‐Membrane‐Layer (EDML) in the anterior chamber (AC). The purpose of this work was to describe a novel approach to teaching anatomy‐based donor and recipient preparation in a DMEK‐Wetlab. We teach successful mono‐manual donor preparation of human corneas in organ culture not suitable for transplantation, including peripheral markers for orientation. We also teach safe recipient preparation in a freshly‐enucleated pig eye in organ culture preservation medium for atraumatic introduction of the EDML roll into the AC, reliable orientation of the EDML during surgery, and stepwise unfolding within the AC. Twenty‐two candidates in the 1. Homburg Cornea Curriculum HCC 2015 who practiced both preparations using three human donor corneas and three pig eyes assessed the procedure as follows: (1) overall grade of the Wetlab 1.4 (median 1, range 1 to 2 ‐ on a scale from 1 (excellent) to 6 (terrible); (2) most participants and tutors stated that the Wetlab is most effective for colleagues who have some previous experience with corneal microsurgery. Our novel anatomy‐based approach to simulating donor preparation and graft implantation for DMEK seems to meet the expectations and requirements of colleagues with previous experience in corneal microsurgery and will help to reduce the rate of complications for incipient DMEK surgeons in the future. Clin. Anat. 31:16–27, 2018. © 2017 Wiley Periodicals, Inc.

[1]  B. Seitz,et al.  Clinical Phenotypes of Fuchs Endothelial Corneal Dystrophy (FECD), Disease Progression, Differential Diagnosis, and Medical Therapy , 2017 .

[2]  Berthold Seitz,et al.  Optical coherence tomography-based topography determination of corneal grafts in eye bank cultivation , 2017, Journal of biomedical optics.

[3]  B. Seitz,et al.  [PKP for Keratoconus - From Hand/Motor Trephine to Excimer Laser and Back to Femtosecond Laser]. , 2016, Klinische Monatsblatter fur Augenheilkunde.

[4]  B. Bachmann,et al.  Intensified Topical Steroids as Prophylaxis for Macular Edema After Posterior Lamellar Keratoplasty Combined With Cataract Surgery. , 2016, American journal of ophthalmology.

[5]  B. Seitz,et al.  The Penetrating Keratoplasty (PKP): A Century of Success , 2016 .

[6]  D. Böhringer,et al.  Graft dislocation and graft failure following Descemet membrane endothelial keratoplasty (DMEK) using precut tissue: a retrospective cohort study , 2016, Graefe's Archive for Clinical and Experimental Ophthalmology.

[7]  W. Lisch,et al.  Die revidierte neueste IC3D-Klassifikation der Hornhautdystrophien , 2015, Klinische Monatsblätter für Augenheilkunde.

[8]  Christopher G. Stoeger,et al.  Diabetes Mellitus Increases Risk of Unsuccessful Graft Preparation in Descemet Membrane Endothelial Keratoplasty: A Multicenter Study , 2014, Cornea.

[9]  D. Böhringer,et al.  Cystoid macular oedema following Descemet membrane endothelial keratoplasty , 2014, British Journal of Ophthalmology.

[10]  D. Böhringer,et al.  Influence of Donor Characteristics on Descemet Membrane Endothelial Keratoplasty , 2014, Cornea.

[11]  K. Bartz-Schmidt,et al.  Comparison of swollen and dextran deswollen organ-cultured corneas for Descemet membrane dissection preparation: histological and ultrastructural findings. , 2013, Investigative ophthalmology & visual science.

[12]  A. Viestenz,et al.  DALK und perforierende Laserkeratoplastik bei fortgeschrittenem Keratokonus , 2013, Der Ophthalmologe.

[13]  B. Seitz,et al.  Immunreaktionen nach Femtosekunden- und Excimerlaser-Keratoplastik , 2013, Klin Monatsbl Augenheilkd.

[14]  B. Seitz,et al.  Prophylaxe und Management von Komplikationen bei perforierender Keratoplastik , 2013, Der Ophthalmologe.

[15]  Heng Chi,et al.  Endothelial cell density after descemet membrane endothelial keratoplasty: 1 to 5-year follow-up. , 2012, American journal of ophthalmology.

[16]  Johanna M. Hofmann,et al.  Precut Verfahren für Descemet-Membran-Endothelzelltransplantation, Präparation und Aufbewahrung in Kultur , 2012, Klinische Monatsblätter für Augenheilkunde.

[17]  D. Tan,et al.  Endothelial keratoplasty: a revolution in evolution. , 2012, Survey of ophthalmology.

[18]  Marianne O Price,et al.  Risk of corneal transplant rejection significantly reduced with Descemet's membrane endothelial keratoplasty. , 2012, Ophthalmology.

[19]  U. Schlötzer-Schrehardt,et al.  A Stepwise Approach to Donor Preparation and Insertion Increases Safety and Outcome of Descemet Membrane Endothelial Keratoplasty , 2011, Cornea.

[20]  D. Ponzin,et al.  Donor tissue preparation for Descemet membrane endothelial keratoplasty , 2010, British Journal of Ophthalmology.

[21]  Claus Cursiefen,et al.  A method to confirm correct orientation of descemet membrane during descemet membrane endothelial keratoplasty. , 2010, American journal of ophthalmology.

[22]  F. Price,et al.  Descemet's membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival. , 2009, Ophthalmology.

[23]  I. J. van der Meulen,et al.  Posterior Lamellar Keratoplasty Using Descemetorhexis and Organ-Cultured Donor Corneal Tissue (Melles Technique) , 2006, Cornea.

[24]  G. Melles,et al.  Descemet membrane endothelial keratoplasty (DMEK). , 2006, Cornea.

[25]  Marianne O Price,et al.  Descemet's stripping with endothelial keratoplasty in 200 eyes: Early challenges and techniques to enhance donor adherence , 2006, Journal of cataract and refractive surgery.

[26]  B. Seitz,et al.  Nonmechanical corneal trephination with the excimer laser improves outcome after penetrating keratoplasty. , 1999, Ophthalmology.