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ISSN 1561-3070 (Electronic)

2013, Number 1

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Rev Cub Oftal 2013; 26 (1)

Two-step pneumatic dissection in the preparation of donor tissue for Descemet membrane endothelial keratoplasty

Capote CA, Ravelo VW, Vinardell PS, Cárdenas DT, Hernández LI, Vigoa AL

Language: Spanish
References: 25
Page: 3-14
PDF size: 490.16 Kb.


ABSTRACT

Objective: to evaluate an alternative of double pneumatic dissection in the preparation of donor tissue for Descemet Membrane endothelial keratoplasty.
Methods: experimental exploratory study of 20 human donor corneas that were useless for corneal transplant was performed in the "Ramón Pando Ferrer" Cuban Institute of Ophthalmology. The technical variant was two-step pneumatic dissection and posterior approach in order to completely detach Descemet membrane. The mean surgical time, the size of the detachment, the arisen complications and histologic examination in cases of atypical biomicroscopic findings were evaluated.
Results: ninety five percent of useful tissue for transplant was obtained. The mean surgical time was 8.5 min and the mean size of bubble was 9.3 mm. Rupture of Descemet membrane occurred in two cases. Three discs presented formation of double bubbles, one partial or two complete ones. The histological study showed that the innermost bubble was made up of an isolated layer of posterior stroma and the outer bubble made up of Descemet membrane and endothelial cells.
Conclusions: this technical variant proved to be reproducible and safe for donor tissue preparation. The ultra-structural characteristics of the posterior deep stroma allow the dissection of an independent layer which is thin, smooth, resistant and transparent. In some specimens, the dissected tissue included not only Descemet membrane and endothelium, but also remnants of the posterior stroma layer in simple bubbles.


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