Histologic analysis of descemet stripping in posterior lamellar keratoplasty.

OBJECTIVE To investigate how precise Descemet stripping works in posterior lamellar keratoplasty (Descemet stripping automated endothelial keratoplasty [DSAEK]) for the treatment of corneal endothelial disorders. METHODS In a prospective, single-center, nonrandomized consecutive series, 20 Descemet membrane specimens obtained after Descemet stripping in DSAEK using a Price hook were examined using histologic analysis and transmission electron microscopy for the presence of residual stroma, thickness of the Descemet membrane, endothelial cell count, and presence of guttae or a posterior collagenous layer. Pathologic findings were correlated with the underlying clinical disease. RESULTS Light and electron microscopy revealed no evidence of adherent rests of corneal stroma in all 20 specimens after Descemet stripping. The mean (SD) total thickness of the Descemet membrane was 21.5 (4.5) microm in peripheral localization and 17.6 (3.8) microm in central localization. The anterior banded layer measured a mean (SD) of 3.0 (0.8) microm thick; the posterior nonbanded layer, 16.7 (5.2) microm thick. The mean (SD) endothelial cell count was 1.7 (1.4) cells per high-power field. Guttae were seen in 15 specimens (75%), and a posterior collagenous layer was found in 3 (15%). CONCLUSION Descemet stripping in DSAEK using the Price hook achieves complete and specific removal of the Descemet membrane without adherent stroma in different underlying endothelial pathologic abnormalities.

[1]  F. Price,et al.  Descemet's stripping with endothelial keratoplasty: comparative outcomes with microkeratome-dissected and manually dissected donor tissue. , 2006, Ophthalmology.

[2]  N. Mamalis,et al.  Histology of Posterior Lamellar Keratoplasty , 2006, Cornea.

[3]  G. Melles.  Posterior lamellar keratoplasty: DLEK to DSEK to DMEK. , 2006, Cornea.

[4]  Mark S Gorovoy,et al.  Descemet-Stripping Automated Endothelial Keratoplasty , 2006, Cornea.

[5]  M. Terry,et al.  Histology of Dislocations in Endothelial Keratoplasty (DSEK and DLEK): A Laboratory-Based, Surgical Solution to Dislocation in 100 Consecutive DSEK Cases , 2006, Cornea.

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

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

[8]  R. Dana,et al.  Nonvascular VEGF receptor 3 expression by corneal epithelium maintains avascularity and vision. , 2006, Proceedings of the National Academy of Sciences of the United States of America.

[9]  M. Terry,et al.  Deep lamellar endothelial keratoplasty: early complications and their management. , 2006, Cornea.

[10]  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.

[11]  M. Terry,et al.  Deep lamellar endothelial keratoplasty visual acuity, astigmatism, and endothelial survival in a large prospective series. , 2005, Ophthalmology.

[12]  F. Price,et al.  Descemet's stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant. , 2005, Journal of refractive surgery.

[13]  P. Mulder,et al.  Endothelial cell density after posterior lamellar keratoplasty (Melles techniques): 3 years follow-up. , 2004, American journal of ophthalmology.

[14]  R. H. Wijdh,et al.  A Technique to Excise the Descemet Membrane From a Recipient Cornea (Descemetorhexis) , 2004, Cornea.

[15]  K. Alitalo,et al.  Lymphatic vessels in vascularized human corneas: immunohistochemical investigation using LYVE-1 and podoplanin. , 2002, Investigative ophthalmology & visual science.

[16]  P. Asbell,et al.  Changing Indications for Penetrating Keratoplasty: Histopathology of 1,250 Corneal Buttons , 1998, Cornea.