Stromal support for Descemet's membrane endothelial keratoplasty

Purpose: To evaluate the use of a peripheral stromal support to facilitate and improve the outcomes of Descemet's membrane endothelial keratoplasty (DMEK). Design: Prospective case series. Participants: Ten patients with Fuchs' endothelial dystrophy. Intervention: Pneumatic dissection was used to detach the central part of the Descemet's membrane and endothelium from the deep stroma. Endothelial grafts including a peripheral stromal support were obtained by eccentric punching of donor tissue and used to perform DMEK surgery in 10 patients. Main Outcome Measures: Operative time, graft attachment rate, best spectacle-corrected visual acuity (BSCVA), endothelial cell loss, refraction, and complications. Results: In all cases the surgical time was â ¤1 hour. The postoperative course was uneventful in all but 2 cases, which required rebubbling owing to early graft detachment. Final attachment rate was 100%. The average follow-up was 8.4 months (range, 612). Postoperative BSCVA was <20/40 in all cases and no substantial change in refraction was recorded. Postoperative endothelial cell loss averaged 24.1% (range, 84.9%). Conclusions: Stromal support facilitates surgery, reduces complications, and appears to maintain the favorable outcomes of DMEK.