Minimizing graft preparation failure in descemet membrane endothelial keratoplasty

Eitan Livny, Esther A.Groeneveld Van Beek, Jessica T. Lie, Kristin M. Mangundap, Marieke Bruinsma, Rénuka S. Birbal, Jacqueline Van Der Wees, Gerrit R.J. Melles*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: To report the failure rate of 2 graft preparation techniques for Descemet membrane endothelial keratoplasty (DMEK) and to evaluate how to minimize graft preparation failure. Methods: Retrospective, nonrandomized study at an eye bank specialized in graft preparation for lamellar keratoplasty. For 1416 donor corneas, the DMEK graft preparation failure rate was evaluated for 2 different techniques, technique I: "Standardized traditional technique" (n = 341) and technique II: "Standardized notouch technique" (n = 933), and for grafts that were converted from technique II to technique I during preparation (n = 142). Results: The overall failure rate averaged 3.9% (55/1416): 7.0% (24/ 341) for technique I and 2.9% (31/1075) for technique II (P , 0.05). Tissue preparations which were converted from technique II to technique I failed in 13.4% (19/142), whereas for grafts that were entirely prepared by technique II, the failure rate was only 1.3% (12/933). The endothelial cell density decrease (before compared with after preparation) did not differ for both techniques (1.1% vs. 0.2%, P . 0.05). Conclusions: Various DMEK graft preparation techniques may provide failure rates of ,4%. A "no-touch preparation" approach (technique II) may combine good graft quality (completely intact endothelial cell layer, ie, negligible preparation-induced endothelial cell density decrease) with low risk of dissection failure, leaving the possibility of conversion to "traditional preparation" (technique I) as a backup method.

Original languageEnglish
Pages (from-to)1452-1457
Number of pages6
Issue number12
StatePublished - 2017
Externally publishedYes


  • Complications
  • Cornea
  • Corneal transplantation
  • Descemet membrane endothelial keratoplasty (dmek)
  • Endothelium
  • Eye bank
  • Graft preparation
  • Posterior lamellar keratoplasty


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