Donor-Tissue Splitting and Tissue Storage for DALK and DMEK Surgery

Abstract

For more than a century, penetrating keratoplasty has been the gold standard for corneal transplantation, but tremendous progress has been made in recent years in improving lamellar keratoplasty techniques, such as deep anterior lamellar keratoplasty (DALK) and Descemet’s membrane endothelial keratoplasty (DMEK). Since in DALK the entire donor cornea except the endothelium-Descemet’s membrane layer is grafted, whereas in DMEK only the donor endothelium-Descemet’s membrane layer is transplanted, a split cornea transplantation approach recently was described by combining DALK and DMEK procedures in two recipients. That means that a single donor button is split into an anterior donor lamella for the use in a DALK procedure in a patient with anterior stromal disease (e.g., keratoconus) and into a posterior donor lamella for the use in a DMEK procedure in a patient with endothelial disease (e.g., Fuchs’ endothelial dystrophy). After splitting, the donor tissue may be stored safely for up to 1 week in organ culture before use in lamellar keratoplasty. This concept of split cornea transplantation will help to reduce donor shortage and cost in corneal transplantation in the future.