Retention of Host Embryonic Descemet Membrane in Endothelial Keratoplasty

Objective: To describe a case of retained host embryonic Descemet membrane (DM) after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: Review of clinical findings in a case of DSAEK with retention of host embryonic DM. Results: A geographic and patchy haze in the interface involving the visual axis was noted postoperatively as soon as 1 week after DSAEK surgery. This was noted on clinical exam and thought to be retained embryonic DM. Review of pathology on the explanted DM confirmed delamination of DM with absence of the anterior embryonic layer and only patchy areas of full-thickness DM. The haze was followed over time and did not regress over the first 6 months after surgery. It did not seem to affect vision significantly, and the patient achieved best spectacle-corrected vision of 20/30 by 6 months. Conclusions: Endothelial keratoplasty is a relatively new technique for posterior corneal transplantation. Variations in operative technique continue to be described. Delamination of DM during stripping can occur; however, retention of host embryonic DM in DSAEK surgery seems to be compatible with good vision.

[1]  A. Tait,et al.  Pathologies , 2006, Pathologies of Climate Governance.

[2]  M. Terry,et al.  Endothelial Keratoplasty: A Simplified Technique to Minimize Graft Dislocation, Iatrogenic Graft Failure, and Pupillary Block , 2008 .

[3]  Chun-Yuan Wang,et al.  Spontaneous resolution of partial donor disk dislocation after deep lamellar endothelial keratoplasty. , 2007, American journal of ophthalmology.

[4]  D. Covert,et al.  Early results of small-incision Descemet's stripping and automated endothelial keratoplasty. , 2007, Ophthalmology.

[5]  B. Zuberbuhler,et al.  Deep Anterior Lamellar Keratoplasty (DALK): Visual Outcome and Complications for a Heterogeneous Group of Corneal Pathologies , 2007, Cornea.

[6]  Luigi Fontana,et al.  Clinical outcomes after deep anterior lamellar keratoplasty using the big-bubble technique in patients with keratoconus. , 2007, American journal of ophthalmology.

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

[8]  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.

[9]  G. Marchini,et al.  Deep lamellar keratoplasty by intracorneal dissection: a prospective clinical and confocal microscopic study. , 2006, Ophthalmology.

[10]  K. Tsubota,et al.  Comparison of deep lamellar keratoplasty and penetrating keratoplasty for lattice and macular corneal dystrophies. , 2006, American journal of ophthalmology.

[11]  W. M. Bourne,et al.  Corneal graft folds: a complication of deep lamellar endothelial keratoplasty. , 2006, Archives of ophthalmology.

[12]  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.

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

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

[15]  M. Terry,et al.  Rapid Visual Rehabilitation After Endothelial Transplants With Deep Lamellar Endothelial Keratoplasty (DLEK) , 2004, Cornea.

[16]  Yen-Po Chen,et al.  Retained Descemet's membrane after penetrating keratoplasty. , 2003, Journal of cataract and refractive surgery.

[17]  M. Terry,et al.  Replacing the endothelium without corneal surface incisions or sutures: the first United States clinical series using the deep lamellar endothelial keratoplasty procedure. , 2003, Ophthalmology.

[18]  T. John Use of indocyanine green in deep lamellar endothelial keratoplasty , 2003, Journal of cataract and refractive surgery.

[19]  M. Terry The Evolution of Lamellar Grafting Techniques Over Twenty-five Years , 2000, Cornea.

[20]  P. Binder,et al.  Posterior lamellar keratoplasty for a case of pseudophakic bullous keratopathy. , 1999, American journal of ophthalmology.

[21]  E. Pels,et al.  A surgical technique for posterior lamellar keratoplasty. , 1998, Cornea.

[22]  S. Masket,et al.  Neodymium:YAG laser optical opening for retained Descemet’s membrane after penetrating keratoplasty , 1996, Journal of cataract and refractive surgery.

[23]  G. H. Kurz,et al.  Retained Descemet's membrane after keratoplasty for old interstitial keratitis. , 1973, American journal of ophthalmology.