Visual And Ultrastructural Analysis After Splitting Of Recipient’S Descemet Membrane During Descemet Membrane Endothelial Keratoplasty
Published 2025 - 43rd Congress of the ESCRS
Reference: PP25.04 | Type: Free paper | DOI: 10.82333/z2bd-xh72
Authors: Hiroko Bissen-Miyajima* 1 , Momoka Midorikawa 1 , Yuka Ota 1 , Keiichiro Minami 1 , Rie Honda 2
1Ophthalmology,Tokyo Dental College Suidobashi Hospital,Tokyo,Japan, 2Ophthalmology,Ogikubo Minamiguchi Eye Clinic,Tokyo,Japan
Purpose
During Descemetorhexis in Descemet Membrane Endothelial Keratoplasty (DMEK), inadvertent lamellar splitting of the recipient’s Descemet membrane (DM) may occur, leaving DM remnants on the posterior corneal surface. This study investigates the influence of lamellar splitting during Descemetorhexis for DMEK on surgical outcome as well as the histological ultrastructure of split DMs.
Setting
Prospective, observational, single-center cohort study in a tertiary hospital in Germany.
Methods
129 pseudophakic eyes of 102 patients with Fuchs Endothelial Corneal Dystrophy or Pseudophakic Bullous Keratopathy were divided into two groups depending on the occurrence of intraoperative splitting. If splitting of the recipient’s DM occurred, the remnants were polished, but no additional surgical manipulation was performed. The primary outcome was the corrected distance visual acuity (CDVA) four months after DMEK. Secondary outcomes were central corneal thickness (CCT), thinnest corneal thickness (TCT), and posterior corneal density (PCD) in Scheimpflug tomography, as well as endothelial cell loss (ECL) and the re-bubbling rate. For histopathological analysis two removed DMs were examined using electron microscopy.
Results
Intraoperative splitting was observed in 36 eyes (27.9%) of all eyes. The postoperative CDVA in the group with splitting (0.12 ± 0.12 logMAR) did not significantly differ from the group without splitting (0.12 ± 0.12 logMAR; p = 0.96). CCT, TCT, PCD, ECL, and the re-bubbling rate also did not significantly differ between both groups four months after DMEK (p > 0.05). In ultrastructural analysis, the split layer had a thickness of 2 µm and showed a rugged splitting interface.
Conclusions
Inadvertent lamellar splitting of the recipient’s DM during DMEK does not have a significant impact on the visual outcome. Therefore, polishing the DM remnants intraoperatively may address this complication in sufficient manner for optimizing visual outcomes.