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Descemet Membrane Thickening as a Sign for the Diagnosis of Corneal Graft Rejection: An Ex Vivo Study

VanDenBerg, Ryan MD; Diakonis, Vasilios F. MD, PhD; Bozung, Alison OD; Gameiro, Gustavo Rosa; Fischer, Oliver MD; El Dakkak, Ahmed MD; Ulloa-Padilla, Jan Paul MD; Anagnostopoulos, Apostolos MD; Dubovy, Sander MD; Abou Shousha, Mohamed MD, PhD

doi: 10.1097/ICO.0000000000001378
Basic Investigation

Purpose: To disclose, using an ex vivo study, the histopathological mechanism behind in vivo thickening of the endothelium/Descemet membrane complex (En/DM) observed in rejected corneal grafts (RCGs).

Methods: Descemet membrane (DM), endothelium, and retrocorneal membranes make up the total En/DM thickness. These layers are not differentiable by high-definition optical coherence tomography; therefore, the source of thickening is unclear from an in vivo perspective. A retrospective ex vivo study (from September 2015 to December 2015) was conducted to measure the thicknesses of DM, endothelium, and retrocorneal membrane in 54 corneal specimens (31 RCGs and 23 controls) using light microscopy. Controls were globes with posterior melanoma without corneal involvement.

Results: There were 54 corneas examined ex vivo with mean age 58.1 ± 12.2 in controls and 51.7 ± 27.9 years in RCGs. The ex vivo study uncovered the histopathological mechanism of En/DM thickening to be secondary to significant thickening (P < 0.001) of DM (6.5 ± 2.4 μm) in RCGs compared with controls (3.9 ± 1.5 μm).

Conclusions: Our ex vivo study shows that DM is responsible for thickening of the En/DM in RCGs observed in vivo by high-definition optical coherence tomography and not the endothelium or retrocorneal membrane.

Bascom Palmer Eye Institute, University of Miami, Miami, FL.

Reprints: Mohamed Abou Shousha, MD, PhD, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136 (e-mail:

Supported by an NEI K23 award (K23EY026118), NEI core center grant to the University of Miami (P30 EY014801), and Research to Prevent Blindness (RPB). The funding organization had no role in the design or conduct of this research.

The authors have no conflicts of interest to disclose.

Presented at the Fall Educational Symposium of the Cornea Society during the American Academy of Ophthalmology Meeting, October 14, 2016, Chicago, IL.

Received June 14, 2017

Received in revised form July 18, 2017

Accepted July 29, 2017

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