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Ludwig M. Heindl, MD; Carmen Hofmann-Rummelt, MTA; Ursula Schlötzer-Schrehardt, PhD; Friedrich E. Kruse, MD; Claus Cursiefen, MD

Arch Ophthalmol. 2008;126(4):461-464.

Objective  To investigate how precise Descemet stripping works in posterior lamellar keratoplasty (Descemet stripping automated endothelial keratoplasty [DSAEK]) for the treatment of corneal endothelial disorders.

Methods  In a prospective, single-center, nonrandomized consecutive series, 20 Descemet membrane specimens obtained after Descemet stripping in DSAEK using a Price hook were examined using histologic analysis and transmission electron microscopy for the presence of residual stroma, thickness of the Descemet membrane, endothelial cell count, and presence of guttae or a posterior collagenous layer. Pathologic findings were correlated with the underlying clinical disease.

Results  Light and electron microscopy revealed no evidence of adherent rests of corneal stroma in all 20 specimens after Descemet stripping. The mean (SD) total thickness of the Descemet membrane was 21.5 (4.5) µm in peripheral localization and 17.6 (3.8) µm in central localization. The anterior banded layer measured a mean (SD) of 3.0 (0.8) µm thick; the posterior nonbanded layer, 16.7 (5.2) µm thick. The mean (SD) endothelial cell count was 1.7 (1.4) cells per high-power field. Guttae were seen in 15 specimens (75%), and a posterior collagenous layer was found in 3 (15%).

Conclusion  Descemet stripping in DSAEK using the Price hook achieves complete and specific removal of the Descemet membrane without adherent stroma in different underlying endothelial pathologic abnormalities.

Author Affiliations: Department of Ophthalmology, University Eye Hospital, University Erlangen-Nürnberg, Erlangen, Germany.

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