Intrastromal descemet membrane transplantation in eyes with advanced keratoconus

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Background. To report the outcomes of intrastromal Descemet membrane (DM) transplantation in corneas with advanced keratoconus.

Materials and methods. Three eyes of 3 patients presented with advanced, progressive keratoconus. None of the eyes had prior UV-crosslinking or any other ocular surgery performed. All eyes had a donor DM implanted into a mid-stromal pocket under local anesthesia, and clinical outcomes were evaluated at 12 months after surgery.

Results. To the best of our knowledge, this is the first report of DM transplantation performed in cases of advanced keratoconus. At 12 months after surgery, the DM graft was well positioned and barely visible within the recipient stroma, and all corneas were clear. None of the eyes showed signs of keratoconus progression throughout the follow-up period. No significant changes were observed in uncorrected (UCVA) and best contact lens corrected visual acuity (BCLCVA), central endothelial cell density (ECD), corneal thinnest point (CTP) pachymetry, and maximum keratometry values (SimK and Kmax). No early or late postoperative complications were observed.

Conclusions. Intrastromal DM transplantation may potentially be an alternative to intrastromal Bowman layer transplantation in eyes with advanced keratoconus, to postpone deep anterior lamellar or penetrating keratoplasty.

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About the authors

Oganes G. Oganesyan

Helmholtz National Medical Research Center of Eye Diseases; A.I. Evdokimov Moscow State University of Medicine and Dentistry


Russian Federation, Moscow

PhD; Department of Ocular Trauma and Reconstructive Surgery

Vostan R. Getadaryan

Helmholtz National Medical Research Center of Eye Diseases

Author for correspondence.

Russian Federation, Moscow


Patimat M. Ashikova

Helmholtz National Medical Research Center of Eye Diseases


Russian Federation, Moscow


Pavel V. Makarov

Helmholtz National Medical Research Center of Eye Diseases


Russian Federation, Moscow


Anush T. Khandzhyan

Helmholtz National Medical Research Center of Eye Diseases


Russian Federation, Moscow

MD, Deputy Director for Commerce


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Supplementary files

Supplementary Files Action
Fig. 1. Intraoperative Video Frames of a Descemet membrane (DM) transplantation of a patient (Case 2) with advanced keratoconus: а – after performing a scleral tunnel incision and filling the anterior chamber with air, the tip of the blade is pushed slightly downward to indicate the dissection depth; b – after the creation of a stromal pocket, a contact lens with DM graft atop is placed in a standard IOL cartridge; c – then, a larger part of the air bubble in the anterior chamber is removed and the contact lens with DM graft is injected into the stromal pocket; d – the contact lens and the DM graft are centered and fully unrolled; e – the contact lens is removed with a forceps; f – at the end of the procedure, the DM graft – endothelium facing downward – is sandwiched between the stromal layers, while no sutures are required to fixate the graft

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Fig. 2. Clinical images of a 29-year-old man with advanced keratoconus who underwent Descemet membrane (DM) transplantation into the stromal pocket (Case 1): а – an eye with advanced keratoconus underwent uncomplicated DM transplantation. The intraoperative image shows the DM graft in the stromal pocket; b and c – 12 months after surgery, the DM graft and its edges are barely visible (yellow arrows); d – biomicroscopy shows a clear cornea; e – optical coherence tomography demonstrates a well positioned DM graft at a depth of two-thirds of the corneal thickness (yellow arrows). Stromal apical thinning and scarring can be seen

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Fig. 3. Topography maps of a cornea before (а, c, e) and 12 months after (b, d, f) Descemet membrane transplantation (a and b, Case 1; c and d, Case 2; e and f, Case 3)

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Copyright (c) 2020 Oganesyan O.G., Getadaryan V.R., Ashikova P.M., Makarov P.V., Khandzhyan A.T.

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