Transplantation of Descemet's membrane carrying viable endothelium through a small scleral incision.

Abstract

To design a technique for transplantation of the Descemet's membrane (DM) as a carrier for its endothelium, while maintaining the low-astigmatic recipient anterior corneal curvature. In a human eye bank eye model, recipient eyes (n = 15) had a 5.0-mm scleral tunnel incision made, extending 1.0 mm into the peripheral cornea. A 9.0-mm-diameter Descemeto rhexis was created, i.e., a circular portion of DM was stripped from the posterior stroma. With use of a custom-made inserter, a 9.0-mm-diameter donor DM carrying autologous donor endothelium was brought into the anterior chamber and positioned against the recipient posterior stroma. The procedure was evaluated by keratometry, endothelial vital and supravital staining, and light microscopy. Mean postoperative astigmatism was 1.0 D (+/-0.6 D). Implanted donor DM showed an intact endothelial cell layer, with 3.4% (+/-1.1%) dispersed focal cell death. Microscopy showed normal endothelial cell morphology and complete apposition of the donor DM against the recipient posterior stroma. DM can be transplanted in vitro with acceptable damage to the donor endothelium and with little induced astigmatism.