A method for true endothelial cell (Tencell) transplantation using a custom-made cannula for the treatment of endothelial cell failure

Abstract

Aim To describe a novel technique, true endothelial cell (Tencell) transplant, for the transfer of donor endothelial cells with only a Descemet's carrier in patients with endothelial cell failure. Method Three patients treated for endothelial cell failure underwent Tencell transplantation. Two were performed to alleviate pain from bullous keratopathy, and one was performed to improve vision. Preoperative pain, vision, and corneal thickness were recorded and compared to the same parameters postoperatively. Results At 3 months postoperatively, all patients were pain free. The visual acuity had improved in all cases, and all three cases demonstrated a reduction of central corneal thickness. In two cases it was possible to perform an endothelial cell count. Conclusion This is the first description of Tencell transplantation in living subjects.

Descemet membrane air-bubble separation in donor corneas

“…[25][26][27] Other techniques that allow grafting of the Descemet-endothelium complex have been proposed and have promising preliminary results. [3][4][5]17 Similar to what has been observed in anterior lamellar keratoplasty, the manual technique dissections for the preparation of the donor lenticule appears to be more demanding than the big-bubble technique. 28,29 A reproducible and minimally traumatic technique to harvest the Descemet-endothelium complex is a prerequisite for a successful endothelial transplant.…”

“…Interest in isolated Descemet membrane transplantation through a self-sealing clear corneal incision, referred to as DMEK, has increased. 17,[19][20][21] In 2008, Melles et al 7 showed the preliminary results of the first 10 cases of DMEK. Modern lamellar techniques share the need of a good donor-to-recipient interface, which influences the final results.…”

Endothelial keratoplasty: DSEK/DSAEK or DMEK - the thinner the better?

“…Transplantation of an isolated donor Descemet membrane and its endothelium, that is, Descemet membrane endothelial keratoplasty (DMEK) [14][15][16]17 ], may be considered a further refinement of the endothelial keratoplasty concept, as it aims to restore the normal corneal anatomy by selective replacement of the diseased corneal layers only (Fig. 1).…”

Donor tissue preparation for Descemet membrane endothelial keratoplasty

“…[12][13][14] The feasibility of an isolated DM transplantation was recently confirmed by Studeny, Tappin, Murraine, and Maloof (Melles, personal communication, 2007). 15,16 For these procedures to be successful, a harvesting technique that provides reproducible tissue qualities may be mandatory to avoid early graft failure and secure long-term graft survival. 17 We therefore reevaluated our technique of stripping DM from the donor posterior corneal stroma to produce isolated Descemet transplants for clinical use.…”