BACKGROUNDThough there have been various methods for harvesting and preserving descemet membrane (DM) and intact endothelium, there is no literature about the morphological evaluation of endothelium after graft preparation for descemet membrane endothelial keratoplasty (DMEK). The aim of this study was to establish and improve a simple method for preparing, preserving, and morphologically evaluating the donor graft for DMEK.

METHODSTo obtain a donor graft, an air bubble was formed by injecting a 29 G needle with 1 ml sterile air into a small edge created outside the Schwalbe line. Another needle was inserted into the bubble through the stroma to aspirate the air or replace half the air with organ culture medium. Trypan blue was used to mark the location for small incision to improve the success rate. Frozen sections were stained with hematoxylin and eosin (HE). Based on the air bubble, DM grafts were divided into four groups: group A (normal control), graft without any operative technique; group B, graft with zero-pressure air bubble; group C, graft with full-pressure air bubble; group D, graft with half-pressure air bubble. The four groups of grafts were preserved for 24 hours to observe the effect of bubbles on cells. The gross and ultrastructure morphologies were evaluated using alizarin red and scanning electron microscopy (SEM), respectively.

RESULTSDonor grafts were harvested via the air bubble technique, facilitated by prior trypan blue staining. HE-stained sections revealed a pure graft without stroma. There were no significant changes under light microscope. In group A, SEM revealed a confluent layer of polygonal endothelium with distributed microvilli exhibiting characteristics of interdigitating junctions. In group B, intercellular borders became thinner. In group C, interdigitations were almost flat and microvilli were observed less frequently. In group D, other than less microvilli, there were minimal changes.

CONCLUSIONSThe donor graft preparation method appears to be effective and convenient. Properly decreasing the air pressure could protect and preserve the endothelium.

Peters' anomaly is a congenital, central corneal stromal opacity usually associated with a defect in the posterior sttroma and Descemet's membrane and anterior synechiae which extend from the pupillary zone of the iris to the periphery of the corneal opacification. The authors experienced a case of Peters' anomaly which occurred in the right eye of 12-day-old male. Under the slit-lamp examination, the right cornea had a central white corneal opacity with adherence of the iris strands to the leukoma and an opaque lens. Intraocular pressure was within normal limits in both eyes.
Cornea ; Corneal Opacity ; Descemet Membrane ; Humans ; Intraocular Pressure ; Iris ; Male

Peters' anomaly is a congenital, central corneal stromal opacity usually associated with a defect in the posterior sttroma and Descemet's membrane and anterior synechiae which extend from the pupillary zone of the iris to the periphery of the corneal opacification. The authors experienced a case of Peters' anomaly which occurred in the right eye of 12-day-old male. Under the slit-lamp examination, the right cornea had a central white corneal opacity with adherence of the iris strands to the leukoma and an opaque lens. Intraocular pressure was within normal limits in both eyes.
Cornea ; Corneal Opacity ; Descemet Membrane ; Humans ; Intraocular Pressure ; Iris ; Male

Following the introduction of instrumentation for phacoemulsification and vitctomy, many other devices have been deaigned to perform the functions. In the past, there was a serious prblem that fluid flowed from the eye along the path of least resistance and the dutflow rate varied greatly with viscosity and consistency of material in the line. Recently a new computerized instrument the Heslin/Mackool Ocusystem that overcame these flow problems was developed and we studied about early experiences using this new helper. The results were as follows: 1. There was an advantage for time and place due to a single instrument and simple change from E.C.C.E. to vitrectomy. 2. The rupture of posterior capsule in aphakic group and the remained cortical material in pseudophakic group were the most common surgical complications during operation. 3. Descemet's membrane stripping was developed in a high rate due to the sharp titanum-covered cap of the handpiece for phacoemulsification. 4. The posterior capsule opacity was the most common postoperative complication in the group of visual acuity less than 0.5.
Descemet Membrane ; Phacoemulsification* ; Postoperative Complications ; Rupture ; Viscosity ; Visual Acuity ; Vitrectomy*

Detachment of Descemet's membrane may occur in congenital glaucoma, birth trauma, keratoconus, Keratoglobus, Terrien's marginal degeneration, surgical and accidental traumas. Most common cause of detachment is a complication of intraocular surgery. We have experienced one case of spontaneous Descemet's membrane detachment in a 56-years-old female who was visited complaining of decreased visual acuity in her left eye of several years' duration. She has not had previous intraocular surgery, trauma and associated disease clinically. We report this case with available literature survery.
Descemet Membrane* ; Female ; Glaucoma ; Humans ; Keratoconus ; Parturition ; Visual Acuity

PURPOSE: To analyze the morphology and density of corneal tissue in patients with early stage Fuchs' corneal endothelial dystrophy (FCED) by in vivo confocal microscopy (IVCM). CASE SUMMARY: Each layer of the cornea in 2 patients with early-stage FCED was examined with IVCM (ConfoScan 4.0, NIDEK, Co. Ltd., albignasego, Italy). Cross-sectioned corneal images of the corneal epithelium, Bowman's layer, stromal layer, Descemet's membrane, and endothelium were evaluated. Corneal epithelium, Bowman's layer, and anterior stroma of both patients showed no abnormalities. Case 1 was diagnosed as Stage 1 FCED, demonstrating typical changes including pleomorphism, polymegathism, and the presence of guttae in the corneal endothelial layer. Case 2 was diagnosed as Stage 2 FCED, showing several hyper-reflective whitish dots in the posterior stroma, hypo-reflective vertical strands in the stroma adjacent to Descemet's membrane, and pleomorphism, polymegathism, and guttae in the corneal endothelial layer. CONCLUSIONS: IVCM is a non-invasive and effective tool to diagnose early-stage FCED.
Cornea ; Descemet Membrane ; Endothelium ; Epithelium, Corneal ; Humans ; Microscopy, Confocal

PURPOSE: To report a case of spontaneously reattached Descemet's membrane detachment, which first occurred during the cataract surgery, and still remained after injection of 100% air into the chamber. CASE SUMMARY: A 78-year-old woman came to the clinic with decreased visual acuity. She had a brunescent cataract and underwent extracapsular cataract extraction with a posterior chamber lens implantation. During the irrigation and aspiration procedure, the Descemet's membrane was torn and detached. An anterior chamber injection of 100% air was performed prior to the conclusion of surgery. Descemet's membrane detachment remained at the center of the cornea and was naturally reattached without any surgical procedure. At 2 months after the surgery, a well-reattached Descemet's membrane and a clear central cornea were observed. CONCLUSIONS: Descemet's membrane detachment is a rare but potentially serious complication of intraocular surgery. The authors report a case of naturally reattached Descemet's membrane detachment which remained after injection of 100% air into the chamber.
Anterior Chamber ; Cataract ; Cataract Extraction ; Cornea ; Descemet Membrane ; Female ; Humans ; Porphyrins ; Visual Acuity

PURPOSE: To report four cases of split cornea transplantation involving separate Descemet membrane keratoplasty and Deep anterior lamella keratoplasty from a single cornea. CASE SUMMARY: Four donor corneas were separated into the endothelium and other layers. The endothelial layers were transplanted into 4 pseudophakic bullous keratopathy patients, and the other layers were stored in corneal storage media. Deep anterior lamella keratoplasties were performed with the stored corneas in 2 lipid keratopathy and 2 keratoconus patients. Postoperatively, all grafted corneas were stable. CONCLUSIONS: The authors report the first 4 cases of split cornea transplantation in Korea, which is experiencing a shortage of donated corneas. Split cornea transplantation will be of benefit to a large number of patients by separating a single cornea into separate layers to be implanted into two patients.
Cornea* ; Corneal Transplantation* ; Descemet Membrane ; Endothelium ; Humans ; Keratoconus ; Korea ; Tissue Donors ; Transplants

This study was conducted to establish the feasibility of corneal transplantation using the big-bubble technique (BBT) to perform deep anterior lamellar keratoplasty (DALK) in three dogs. After the cornea was trephined 750 µm, 4 mL of air was injected, and the blanched stroma was removed to expose Descemet's membrane (DM). The donor corneal button, which was gently stripped off the DM, was sutured onto the bare DM of the recipient cornea. The dogs received topical antibiotics every 6 h for 7 days and 2% cyclosporine ointment every 12 h for 1 month. The eyes were examined post-operatively at 7, 14, 21, 28 and 150 days. The central portion of the transplanted cornea stayed transparent while corneal haze developed around the transplanted margin. Menace response was normal even though the transplanted cornea was edematous until 3 weeks after surgery. A marginal haze was rarely observed between the donor and recipient corneas at 150 days after the operation. A spotted haze developed in the central part of the deep stroma near the DM. Upon histopathological examination, the stroma and epithelium of the donor cornea had normal structures. Corneal transplantation using DALK with BBT can be performed in dogs preserving the healthy endothelium.
Animals ; Anti-Bacterial Agents ; Cornea ; Corneal Transplantation* ; Cyclosporine ; Descemet Membrane ; Dogs* ; Endothelium ; Epithelium ; Humans ; Tissue Donors

Posterior polymorphous dystrophy is a bilateral, dominantly inherited (rarely recessively inherited) disorder of corneal endothelium, characterized by a spectrum of changes in posterior cornea and less commonly in the iris and angle structures. We have experienced a 39-year-old male patient complaining of visual disturbance in the right eye. On examination, we found characteristics of postenor polymorphous dystrophy which were Descemet's membrane thickening. peripheral anterior synechiae, iridocorneal adhesion. abnormal corneal endothelial cells in both eyes, and corneal epithelial and stromal edema in the right eye and after penetrating keratoplasty, the result was good. Therefore, we report a case of posterior polymorphous dystrophy with review of literatures.
Adult ; Cornea ; Descemet Membrane ; Edema ; Endothelial Cells ; Endothelium, Corneal ; Humans ; Iris ; Keratoplasty, Penetrating ; Male