Abstract
BackgroundCorneal transplantation has rapidly evolved from full-thickness penetrating keratoplasty (PK) to selective tissue corneal transplantation, where only the diseased portions of the patient's corneal tissue are replaced with healthy donor tissue. Descemet's membrane endothelial keratoplasty (DMEK) performed in patients with corneal endothelial dysfunction is one such example where only a single layer of endothelial cells with its basement membrane (10–15 µm in thickness), Descemet's membrane (DM) is replaced. It is challenging to replace this membrane due to its intrinsic property to roll in an aqueous environment. The main objective of this study was to determine the effects of fibrin glue (FG) on the biomechanical properties of DM using atomic force microscopy (AFM) and relates these properties to membrane folding propensity.Methodology/Principal FindingsFibrin glue was sprayed using the EasySpray applicator system, and the biomechanical properties of human DM were determined by AFM. We studied the changes in the “rolling up” tendency of DM by examining the changes in the elasticity and flexural rigidity after the application of FG. Surface topography was assessed using scanning electron microscopy (SEM) and AFM imaging. Treatment with FG not only stabilized and stiffened DM but also led to a significant increase in hysteresis of the glue-treated membrane. In addition, flexural or bending rigidity values also increased in FG-treated membranes.Conclusions/SignificanceOur results suggest that fibrin glue provides rigidity to the DM/endothelial cell complex that may aid in subsequent manipulation by maintaining tissue integrity.
Highlights
Corneal endothelial dysfunction accounts for the majority of corneal transplantations performed worldwide
Descemet’s membrane (DM) scaffolding and histological analysis The fibrin glue (FG) sprayed on DM from a distance of 5 cm and a pressure of 10 psi using the EasySpray system distributes a uniform layer of glue over the membrane surface
Histological examination under light microscopy using hematoxylin and eosin staining of sections cut from DM embedded in OCT with FG showed an increase in tissue thickness of,50 mm (Fig. 3D) as measured with ImageJ software [35] compared to a native DM (Fig. 3C)
Summary
Corneal endothelial dysfunction accounts for the majority of corneal transplantations performed worldwide. In DSAEK, the donor endothelial cell layer is transplanted together with a thin layer of accompanying stromal tissue (100–200 mm) that acts as a scaffold and confers some structural rigidity to the donor tissue This structural element allows the delicate donor tissue to be manipulated and delivered into the anterior chamber of the eye, where the graft is subsequently attached to the posterior surface of the host cornea by an air bubble [10,11]. Descemet’s membrane endothelial keratoplasty (DMEK) performed in patients with corneal endothelial dysfunction is one such example where only a single layer of endothelial cells with its basement membrane (10–15 mm in thickness), Descemet’s membrane (DM) is replaced. The main objective of this study was to determine the effects of fibrin glue (FG) on the biomechanical properties of DM using atomic force microscopy (AFM) and relates these properties to membrane folding propensity
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