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Research Letters |

Corneal Graft Alterations After Descemet Stripping: Implications for Split Cornea Transplantation

Ludwig M. Heindl, MD, PhD; Stephan Riss, MD; Werner Adler, PhD; Philipp Steven, MD, PhD; Deniz Hos, MD; Claus Cursiefen, MD, PhD
JAMA Ophthalmol. 2013;131(5):687-689. doi:10.1001/jamaophthalmol.2013.794.
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In recent years, there has been tremendous progress in improving lamellar keratoplasty techniques such as deep anterior lamellar keratoplasty1,2 and Descemet membrane endothelial keratoplasty.3,4 Splitting of a single donor cornea into an anterior part (including epithelium, its basement membrane, Bowman layer, and stroma) for use in a deep anterior lamellar keratoplasty procedure in a patient with anterior stromal disease (eg, keratoconus) and into a posterior part (endothelium–Descemet membrane layer) for use in a Descemet membrane endothelial keratoplasty procedure in a patient with endothelial disease (eg, Fuchs endothelial dystrophy) can reduce the need and cost for corneal donor tissue by up to 47%.57 Since it is thus far unclear what time limits are acceptable for storing anterior and posterior grafts in split cornea transplantation, we investigated split corneal tissue for temporal morphologic alterations after Descemet stripping.

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Figure 1. Histopathologic analysis of split (A, B, D, and E) and full-thickness (C and F) donor corneas after 1 (A-C) and 3 (D-F) additional weeks of organ culture showing more epithelial and stromal edema after Descemet stripping with marked loss of keratocytes in the anterior stroma at 3 culture weeks and Descemet membrane with intact and viable endothelium up to 3 culture weeks without significant differences between stripped and nonstripped buttons (hematoxylin-eosin, original magnification ×200).

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Figure 2. Transmission electron microscopy of split (A-C and G-I) and full-thickness (D-F and J-L) donor corneas after 1 (A-F) and 3 (G-L) additional weeks of organ culture showing more epithelial (A, D, G, and J) and stromal (B, E, H, and K) edema after Descemet stripping and Descemet membrane with intact and viable endothelium (C, F, I, and L) up to 3 culture weeks without significant differences between stripped and nonstripped buttons (scale bars = 2.5 μm).

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