Session Title: Cornea
Session Date/Time: Sunday 05/02/2012 | 08:30-11:00
Paper Time: 09:46
Venue: Hall 1
First Author: : J.Parker UNITED STATES
Co Author(s): : M. Dirisamer I. Dapena L. Ham K. van Dijk J. van der Wees G. Melles
Purpose:
To describe various endothelial migration healing patterns after Descemet membrane endothelial keratoplasty (DMEK), to determine the contribution of the donor and host endothelium in the clearance of a transplanted cornea.
Setting:
Non-randomized, prospective clinical study, at a tertiary referral center. Netherlands Institute for Innovative Ocular Surgery, Rotterdam.
Methods:
In a total of 150 consecutive eyes that underwent DMEK, ie transplantation of an isolated Descemet graft, for Fuchs endothelial dystrophy, re-endothelialization patterns were studied. Of these eyes, 36 showed a ‘stromal gap’ between the ‘descemetorhexis-edge’ and the graft, or (partial) graft detachment. Endothelialization patterns of the host posterior stroma were documented at 1, 3, 6, 9, 12 and 24 months after surgery with Pentacam imaging, specular microscopy, optical coherence tomography, confocal microscopy, and slit-lamp biomicroscopy. RESULTS Complete corneal clearance was seen in 28/36 (78%) eyes with a stromal gap, or (partial) detachment, progressing from the periphery toward the center; and 27/34 (79%) of eyes with normal visual potential reached a visual acuity of ≥20/40 (≥0.5) or better. In three eyes that had the Descemet graft implanted upside-down, a ‘reversed corneal clearance pattern‘ was observed, ie persistent edema where the graft was attached, while the area overlying the detachment cleared.
Conclusions:
The presence of donor endothelium in the recipient anterior chamber may be required for endothelial migration and/or recovery of corneal clarity. Re-endothelialization may be associated with massive endothelial migration, and some form of cell signaling to draw donor endothelial cells toward the recipient posterior stroma (‘homing’).
Financial Disclosure:
No
