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

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

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*

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 investigate wound characteristics and ultrastructural changes in the 2.2-mm and 2.8-mm main corneal incisions. METHODS: Forty-four eyes of 34 patients undergoing cataract surgery were randomized to receive a 2.2-mm or 2.8-mm main corneal incision. All incisions were evaluated 1, 7, and 30 days postoperatively using anterior segment optical coherence tomography. The angle, length, maximal thickness of the incision, and if present, corneal gap length and incision gap area were calculated. The existence of Descemet's membrane detachment was recorded. RESULTS: The mean endothelial gap length and gap area of the 2.2-mm wound were larger than the 2.8-mm, with the only statistically significant difference observed on postoperative day 30 (p = 0.015 and 0.027, respectively). There was no difference in the mean incision angle, length, and corneal thickness between the 2 incision sizes. The ratio of Descemet's membrane detachment increased with older age and low postoperative IOP, but not associated with incision size (p < 0.05). CONCLUSIONS: Both the 2.2-mm and 2.8-mm main corneal incisions showed excellent wound healing outcome without significant postoperative complications. Older patients with low postoperative IOP required a more careful wound care management. The incision parameters in the present study can be used as an indicator of the healing process to reduce wound-related complications.
Cataract ; Descemet Membrane ; Eye ; Humans ; Phacoemulsification ; Postoperative Complications ; Tomography, Optical Coherence ; Wound Healing

The Kayser-Fleischer ring, a characteristic finding in Wilson's disease, occurs in the corneal periphery and is usually yellow-brown but may by red, blue, green, ormixture of any these colors. The Kayser-Fleischer ring, copper deposition at the level of the posterior position of Descemet's membrane, is about 1 to 3mm in width and extends to the limbus without a lucid interval. In addition to involvement of Descemet's membrane, one may find anterior subcapsular sunflower cataract in Wilson's disease. The authors have recently experienced two cases of Wilson's disease. One case, a 17-year-old boy, has Kayser-Fleischer rings and anterior subcapsular sunflower cataracts in both eyes and the other, a 17-year-old aldolescent male, has dense yellow-green colored Kayser-Fleischer rings in both eyes. Both cases have been treated with penicillamine(1gr/day) and low copper diet. After treatment, clinical manifestations have been improved markedly but the Kayer-Fleischer rings have not disappeared yet.
Adolescent ; Cataract ; Copper ; Descemet Membrane ; Diet ; Helianthus ; Hepatolenticular Degeneration ; Humans ; Male

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

PURPOSE: To evaluate the clinical results of intrastromal ring segment (Keraring(R)) implantation using a femtosecond laser in patients with keratectasia. METHODS: Twenty eyes of 19 keratectatic patients (15 eyes of keratoconus and five eyes of post-LASIK keratectasia) who completed at least three months of postoperative follow-up were included in this study. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent, keratometric value, corneal astigmatism, corneal higher order aberrations (HOA) and specular microscopy were determined or performed before and after surgery. In addition, intraoperative and postoperative adverse complications were recorded. RESULTS: UCVA improved in 13 out of 20 eyes (65%), and BSCVA improved in 16 out of 20 eyes (80%). At the postoperative examination there was no statistically significant reduction in the spherical equivalent with that observed at the examination before implantation. Conversely, there were statistically significant reductions in topographic mean K value and Sim K astigmatism, corneal total and coma-like HOA (p<0.05). On specular microscopy, there was no statistically significant difference between preoperative and postoperative endothelial cell density. There was one case of partial Descemet membrane detachment and one case of microperforation as a complication during surgery, which recovered over time without any treatment. CONCLUSION: Keraring(R) implantation appears to be an effective and safe procedure for improving visual acuity and stabilizing corneal refractive power in keratectactic patients.
Aniline Compounds ; Astigmatism ; Descemet Membrane ; Endothelial Cells ; Eye ; Follow-Up Studies ; Humans ; Keratoconus ; Microscopy ; Visual Acuity