Biomechanical evaluation of central and peripheral Descemet’s membrane endothelial graft

Vito Romano, Zhuola Zhuola, Zhuo Chang, Bernhard Steger, Hannah J. Levis, Stephen B. Kaye, Riaz Akhtar

Abstract


Corneal endothelial transplant is the gold-standard treatment in cases of corneal endothelial cellular dysfunction. Preparation, delivery, and unfolding of the graft are technically demanding. We assessed the biomechanical behavior of Descemet’s membrane to better understand Descemet’s membrane endothelial keratoplasty(DMEK) graft behavior, and to select the right diameter and donor age graft . The biomechanical behavior was tested using atomic force microscopy (AFM) on five corneas unsuitable for transplantation. The peripheral cornea was found to be stiffer than the central cornea (3171.89 MPa and 2837.20 MPa, respectively). The elastic modulus of both the central and peripheral cornea exhibited a trend to decrease with age. In addition, the central cornea becomes stiff er than the peripheral cornea in older patients, while the peripheral cornea was stiff er in younger patients. AFM is a suitable technique for evaluating biomechanical behavior of DMEK graft s. One interpretation of this varied behavior is that the type and quantity of collagen changes with age and location.


Keywords


atomic force microscopy (AFM); biomechanical behavior; corneal transplant; endothelial keratoplasty

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References


Anshu A, Price MO, Tan DT, Price FW, Jr. Endothelial keratoplasty: a revolution in evolution. Surv Ophthalmol. 2012;57(3):236-252.

Dapena I, Ham L, Melles GR. Endothelial keratoplasty: DSEK/DSAEK or DMEK--the thinner the better? Curr Opin Ophthalmol. 2009;20(4):299-307.

Dapena I, Moutsouris K, Ham L, Melles GR. Graft detachment rate. Ophthalmology. 2010;117(4):847-e1.

Fernandez Lopez E, Baydoun L, Gerber-Hollbach N, Dapena I, Liarakos VS, Ham L, et al. Rebubbling techniques for graft detachment after Descemet membrane endothelial keratoplasty. Cornea. 2016;35(6):759-764.

O’Brien PD, Lake DB, Saw VP, Rostron CK, Dart JK, Allan BD. Endothelial keratoplasty: case selection in the learning curve. Cornea. 2008;27(10):1114-1148.

Parekh M, Ruzza A, Ferrari S, Ahmad S, Kaye S, Ponzin D, et al. Endothelium-in versus endothelium-out for Descemet membrane endothelial keratoplasty graft preparation and implantation. Acta Ophthalmol. 2017;95(2):194-198.

Romano V, Parekh M, Ruzza A, Willoughby CE, Ferrari S, Ponzin D, et al. Comparison of preservation and transportation protocols for preloaded Descemet membrane endothelial keratoplasty. Br J Ophthalmol. 2017. doi: 10.1136/bjophthalmol-2017-310906.


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