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Influence of Donor Characteristics on Descemet Membrane Endothelial Keratoplasty

Heinzelmann, Sonja MD; Hüther, Silja; Böhringer, Daniel MD; Eberwein, Philipp MD; Reinhard, Thomas MD; Maier, Philip MD

doi: 10.1097/ICO.0000000000000106

Purpose: Penetrating keratoplasty is being replaced by posterior lamellar techniques like Descemet stripping automated endothelial keratoplasty or Descemet membrane endothelial keratoplasty (DMEK) for the surgical treatment of patients with endothelial insufficiency. Although DMEK leads to the best visual results, Descemet stripping automated endothelial keratoplasty is still the standard procedure for many surgeons because it is technically more standardized. Here, we investigated how donor characteristics may influence DMEK surgery.

Methods: After in vitro preparation of DMEK grafts (n = 28), we measured the width of the graft roll, which we correlated to various donor characteristics. In 31 DMEK cases, we measured the intraoperative time from implantation to attachment of the graft, which we correlated to the respective donor characteristics and endothelial cell loss. We used Pearson's method and a multifactorial linear model for the statistical assessments.

Results: We found a statistically significant correlation between donor age (P < 0.001) and endothelial cell density (P < 0.05), and the width of the DMEK rolls. That is, older donors and grafts with higher endothelial cell densities formed broader graft rolls. Donor age also showed a trend to directly influence the unfolding time that took longer using younger grafts. Furthermore, the relative endothelial cell loss increased with longer unfolding times.

Conclusions: We found that donor age and endothelial cell density influence the properties of DMEK grafts, and thereby the duration of the surgical procedure. Increased unfolding times result in higher endothelial cell loss. Therefore, it seems reasonable to accept preferably older donors with high endothelial cell densities for DMEK, which may be particularly true for inexperienced surgeons or complex clinical situations.

Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.

Reprints: Philip Maier, University Eye Hospital Freiburg, Killianstr 5, 79106 Freiburg, Germany (e-mail:

The authors have no funding or conflicts of interest to disclose.

All authors have equally contributed to conception and design, or acquisition of data, or analysis and interpretation of data; and drafting the article or revising it critically for important intellectual content; final approval of the version to be published.

S. Heinzelmann and P. Maier had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Received December 12, 2013

Accepted February 03, 2014

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.