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A Technique to Excise the Descemet Membrane From a Recipient Cornea (Descemetorhexis)

Melles, Gerrit R. J. MD, PhD* † ‡ §; Wijdh, Robert H. J. MD; Nieuwendaal, Carla P. MD

Clinical Sciences

Objective: To describe a technique for excision of the Descemet membrane (DM) from the recipient eye for preparation of a recipient stromal bed in posterior lamellar keratoplasty.

Methods: In 10 human eye bank eyes and 3 patients, recipient eyes had a 5.0-mm scleral tunnel incision made extending 1.0 mm into the peripheral cornea at the 12 o’clock surgical position. The anterior chamber was completely filled with air, and a reflective glide was placed through the incision onto the iris, to better visualize DM. A 9.0-mm mark was made onto the corneal epithelium to outline the area from which the Descemet membrane was to be removed. With a custom-made scraper, the DM was then carefully stripped off the posterior stroma by loosening the membrane at the 6 o’clock position and pulling it toward the incision at 12 o’clock. The excised DMs were evaluated by light and electron microscopy.

Results: In all recipient eyes, DM could be easily and completely removed from the posterior corneal stroma. Microscopy showed isolated DMs without stromal tissue elements.

Conclusion: With the technique described, DM can be excised in a controlled fashion without damaging the posterior corneal stroma, to quickly create a recipient stromal bed before implantation of a donor posterior lamellar disk in posterior lamellar keratoplasty.

From the *Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; †the University Hospital Groningen, Groningen, The Netherlands; ‡the Academic Medical Center, Amsterdam, The Netherlands; and the §Department of Ophthalmology, Fondation Rothschild, University of Paris, France.

Received for publication August 5, 2003; revision received November 13, 2003; accepted November 13, 2003.

The Netherlands Institute for Innovative Ocular Surgery has a proprietary and financial interest in the products and procedure described. Patents pending.

Reprints: Gerrit R. J. Melles, MD, PhD, The Netherlands Institute for Innovative Ocular Surgery, H. A. Maaskantstraat 31, 3071 MJ Rotterdam, The Netherlands (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.