With the development of Descemet's membrane
endothelial keratoplasty (DMEK), an excellent clinical outcome is seen in the treatment of corneal endothelial dysfunctions.
DSEK involves the removal and replacement of the posterior portion of the cornea either the endothelial layer only or it may include Descemet's membrane
, depending on the accuracy of the dissection.
Keratoconus, Keratoglobus, Pellucid marginal degeneration, keratectasia following refractive surgery, Stromal opacities/scars sparing Descemet's membrane
and Corneal dystrophies involving anterior/deep stroma.
If the erosion continues to Descemet's membrane
, a deep ulcer called a descemetocele forms.
was stripped with a reverse Sinskey hook utilizing the epithelial mark as a guide (Figure 1(e)).
Scientists previously believed the cornea to be composed of five layers, from front to back, the corneal epithelium, Bowman's layer, the corneal stroma, Descemet's membrane
and the corneal endothelium.
These are, from the outermost to the innermost, the epithelium; Bowman's membrane; the stroma; Descemet's membrane
, and the endothelium .
Twelve hours later, vision had improved to 6/9 and 6/12 and folding of Descemet's membrane
In the XX century, Sato in Japan, in the 1930s, observed corneal flattening in keratoconus eyes with previous steep and thin corneas, which developed hydrops (rupture of the Descemet membrane with subsequent hydration of the stroma) and thought that breaks in Descemet's membrane
might play a role in that flattening, so he attempted to treat keratoconus creating breaks in Descemet's membrane
with posterior incisions.
Descemet's stripping and automated endothelial keratoplasty uses a mechanical microkeratome to harvest the donor corneal lenticule and mechanical stripping of the diseased host endothelium and Descemet's membrane
If the concern is a diffuse opacity, think of buphthalmos, congenital endothelial dystrophy, mucopolysaccharidosis, cystinosis, or hydrops (a break in the Descemet's membrane
that causes rapid hydration and clouding of the cornea).
A child may present with signs of previous hydrops due to forceps delivery, which can cause breaks in Descemet's membrane
and leave corneal scarring, highlighting the importance of taking a careful history.