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Technique for Preparation of the Corneal Endothelium-Descemet Membrane Complex for Transplantation

Zhu, Zejin MD, PhD*; Rife, Lawrence BS; Yiu, Samuel MD, PhD*†; Trousdale, Melvin D PhD*†; Wasilewski, Daniel MD*; Siqueira, Alexandre MD*; Smith, Ronald E MD*†

doi: 10.1097/01.ico.0000214229.21238.eb
Basic Investigation
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Purpose: Replacing diseased corneal endothelium with a preparation of Descemet membrane carrying functional endothelium and no stroma may be a feasible method for treating corneal endothelial decompensation. To obtain a viable donor of a Descemet membrane endothelium disc, we modified the Descemet membrane stripping technique and monitored the percentage of endothelial damage to the donor tissue preparation.

Methods: Forty-eight human corneas were used. Cornea buttons were mounted on an artificial anterior chamber, endothelial side up. Endothelia were stained with alizarin red, examined under the microscope, and photographed at 5 different sites (microscope, ×100; digital magnification, ×2.83). A 6 × 7-mm rectangular piece of endothelium-Descemet membrane complex was obtained using a Grieshaber microsurgical knife and Kelman-McPherson forceps. Digital photographs of endothelia were analyzed with a computer, and the percentage of endothelial damage was calculated. Specimens were processed for hematoxylin-eosin staining.

Results: Forty of 48 endothelium-Descemet membrane preparations (83.3%) were complete peels with minimal endothelial damage. Endothelial damage before and after the surgery was 1.57 ± 2.11% and 2.61 ± 1.77%, respectively. Eight preparations (16.7%) failed because of tearing. Multiple hematoxylin-eosin-stained sections showed the presence of endothelium with intact Descemet membrane and no stromal tissue.

Conclusion: We modified the technique of Melles and obtained a sheet of Descemet membrane and endothelium with minimal endothelial damage and with no remaining stroma observed. This simple technique can be used to obtain the endothelium-Descemet membrane complex in minutes. It may be useful for corneal endothelium transplantation.

From the *Doheny Eye Institute, Los Angeles, CA; and the †Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA.

Received for publication March 1, 2005; revision received December 1, 2005; accepted December 6, 2005.

Supported in part by NEI Core Grants EY03040 and EY12689 and an unrestricted grant from Research to Prevent Blindness.

Reprints: Ronald E. Smith, MD, Doheny Eye Institute, 1450 San Pablo Street, Los Angeles, CA 90033 (e-mail: rsmith@doheny.org).

© 2006 Lippincott Williams & Wilkins, Inc.