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.

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

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 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: To analyze the morphology and density of corneal tissue in patients with bullous keratopathy using in vivo confocal microscopy (IVCM). CASE SUMMARY: Four eyes of 4 patients with clinically diagnosed bullous keratopathy were examined using IVCM. Cross-sectioned corneal images of the corneal epithelium, Bowman's layer, stromal layer, Descemet's membrane, and endothelium were evaluated. In bullous keratopathy patients, the outline of corneal epithelial wing cells was blurred. Several hyper-reflective whitish dots were found at the corneal epithelial level and a reduction in the density and thickness of the corneal nerves was observed. There was also a reduction in the density of the stromal keratocytes. The outline of the stromal keratocytes was blurred. Some keratocytes resembled myofibroblast. The hypo-reflective vertical strands were observed in the stroma adjacent to the Descemet's membrane. Endothelium showed hyper-reflectivity with associated increased endothelial pleomorphism and polymegathism. CONCLUSIONS: In patients with bullous keratopathy, IVCM showed tissue edema in the corneal epithelium, stroma, and endothelium. Hyper-reflectivity appearances were noted due to the increase in the metabolic rate of the cells or extracellular matrix accumulation. Corneal endothelium showed morphological changes.
Descemet Membrane ; Edema ; Endothelium ; Endothelium, Corneal ; Epithelium, Corneal ; Extracellular Matrix ; Humans ; Microscopy, Confocal ; Myofibroblasts

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: 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