Endothelial grafts with manually dissected endothelio‐Descemet. Eye bank and surgical point of view

Abstract

Abstract Purpose to describe a manual technique for the preparation of thin endothelial grafts or DMEK and to report clinical results in patients with Fuchs dystrophy. Methods We report here a series of 92 patients with Fuchs dystrophy undergoing endothelial keratoplasty. A manual dissection is performed on an artificial chamber to obtain posterior graft. After completing the learning curve, it is possible to select the depth of dissection: from pure descemet membrane isolation, to very thin posterior graft. Results Visual acuity is significantly higher after DMEK (0.7) than after thin posterior grafts (0.58), 6 months after surgery. However, endothelial density is much lower with 1190 cel/mm² after DMEK compared to thin posterior grafts which have 1870 cell/mm² 6 months after grafting. Conclusion Manual dissection is more difficult to perform than automated techniques but allow preparation of much thinner grafts. Among these, pure descemet membrane grafts have the best visual rehabilitation but less endothelial cells due to surgical manipulations.