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.

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*

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

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

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

PURPOSE: To present a case of a 72-year-old woman with posterior polymorphous corneal dystrophy (PPCD) combined with traumatic Descemet's membrane fold due to forceps injury in Birth. CASE SUMMARY: A 72-year-old woman without significant ocular history presented complaining of ocular discomfort in her right eye. She had a history of birth that required forceps delivery and poor vision in the right eye since childhood. The rest of perinatal ophthalmic history was unremarkable (no past ophthalmic or family history). The best corrected visual acuity was 20/20 in both eyes. Slit-lamp biomicroscopy showed distinctive, vertical, semitranslucent Descemet's membrane breaks situated on the superior temporal side of the posterior surface of the cornea in her right eye. Also, a horizontal, tram-track line appearance of posterior cornea surface was detected at middle and inferior side of cornea. The fellow eye was normal. The endothelial cell densities were 945 cells/mm2 and 2481 cells/mm2 in right and left eyes, respectively. After 11 years later, (routine follow up exams every 1 year), the endothelial cell densities were 901 cells/mm2 and 2481 cells/mm2 in right and left eyes, respectively, which means there were no significant changes of endothelial densities in both eyes. CONCLUSIONS: We report a case of a patient with posterior polymorphous corneal dystrophy (PPCD) combined with traumatic Descemet's membrane fold due to forceps injury in Birth. The disease does not seem to progress or aggravated in long term follow up and no specific treatment was required.
Aged ; Cornea ; Descemet Membrane* ; Endothelial Cells ; Female ; Follow-Up Studies ; Humans ; Parturition ; Surgical Instruments ; Visual Acuity

PURPOSE: To analyze the morphology of corneal tissue in patients with Amiodarone-induced vortex keratopathy by in vivo confocal microscopy (IVCM). CASE SUMMARY: Four eyes of 2 patients with clinically diagnosed Amiodarone-induced vortex keratopathy were examined using corneal topography and IVCM. Cross-sectioned corneal images of the corneal epithelium, Bowman's layer, stromal layer, Descemet's membrane, and endothelium were evaluated. Location of corneal deposits examined by conventional slit-lamp microscopy was correlated with findings of corneal topography. The curvature map of corneal topography revealed an unusual irregular astigmatism with generalized mild steepening consistent with the location of the corneal deposits and the elevation map showed the change of corneal elevation according to the corneal deposits. Multiple hyper-reflective whitish dots were found at the corneal epithelial level and some were found at the anterior stromal level. Regarding the corneal endothelial layer, case 1 demonstrated normal corneal endothelial tissue, but case 2 showed several hyper-reflective whitish dots in the endothelium. CONCLUSIONS: In patients with Amiodarone-induced vortex keratopathy, IVCM showed corneal deposits in the corneal epithelium, stroma, and endothelium. Distribution of microdeposits in the corneal tissue caused an irregular astigmatism.
Astigmatism ; Corneal Topography ; Descemet Membrane ; Endothelium ; Epithelium, Corneal ; Humans ; Microscopy ; Microscopy, Confocal

PURPOSE: We intend to report that a case of total Descemet's membrane detachment, occured after cataract operation which was reattached with non-expansible SF6 gas infusion. METHODS: 77-year-old woman who was undertaken cataract surgey 7days ago showed corneal edema, decreased visual acuity and rolled detached Descemet's membrane which was attached inferior cornea. Nine days after cataract surgery, 0.25 ml of non-expansible SF6 gas 20% was infused into anterior chamber. RESULTS: Three days after intracameral injection of non-expansible SF6 gas 20%, Descemet's membrane was begin to reattach and corneal edema was improved progressively. CONCLUSIONS: When total Descemet's membrane detachment occurs after intraocular surgery, intracameral injection of non-expansible SF6 gas is to be a effective treatment.
Aged ; Anterior Chamber ; Cataract ; Cornea ; Corneal Edema ; Descemet Membrane ; Female ; Humans ; Visual Acuity