This case report describes a novel technique where one quarter of Descemet’s membrane (DM) was transplanted during a quarter-descemet membrane endothelial keratoplasty (DMEK) procedure. DMEK graft was prepared from a 58-year-old corneo-scleral donor after one week in culture. Peripheral DM including the trabecular meshwork was stripped from the posterior stroma, leaving the central part attached. The corneo-scleral button was then divided into four equal parts. DM was stripped off, yielding four DM sheets. Endothelial cell morphology was evaluated before and after graft preparation. All quarter-DMEK grafts were stored in organ culture until transplantation. Quarter-DMEK surgery and postoperative treatment followed standard DMEK protocol. The DM graft was positioned into right orientation by indirect external manipulation and with aid of air bubble lifted into its place. At the end, the anterior chamber was left completely filled with air for 60 minutes after which partial air-fluid exchange was performed. Patients who underwent quarter-DMEK for Fuchs’ endothelial dystrophy achieved 20/20 visual acuity at three months. Postoperative donor endothelial cell decreased to 846cells/mm2 at three months from preoperative 2700 cells/mm2. No intraoperative or postoperative complications were described. This report shows quarter DMEK as a feasible surgical option, able to achieve both good visual recovery and optimal tissue donor economy. However long-term graft survival and endothelial cell counts are currently unknown.

Case report of quarter–descemet membrane endothelial keratoplasty for Fuchs endothelial dystrophy.
Müller T, Lavy I, Baydoun L, et al.
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Magdalena Popiela

Royal Gwent Hospital, Cardiff, UK.

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