An approach to reduce Descemet’s membrane scrolling: Relevance to Descemet’s membrane endothelial keratoplasty (DMEK)

Abstract

Background/Objectives: To determine whether Descemet’s membrane (DM) scrolling occurs primarily along the vertical or horizontal axis and establish whether oval trephination along the axis of least scrolling can reduce the grade of the scroll. Subjects/Methods:The longest limbus-to-limbus axis on 28 sclero-corneal discs was taken as the horizontal axis. The horizontal (n=7) or (right angles to it) vertical (n=6) axis was marked on the DM before peeling it off. The direction and grade of scrolling was observed. Narrow strips (3-4mm wide) were then cut along the two axes (n=4 each) and the scrolling pattern observed. Ellipses (7x9mm) of DM were punched along the two axes (n=6 each) and the scrolls graded. Immunofluorescent staining for elastin, on horizontal and vertical tissue sections from 3 DM samples was performed. The intensity and thickness of elastin staining were measured. Results: 24 (85.72%) DM samples showed scrolling along the horizontal axis, none along the vertical axis, and 4 (14.28%) showed a spiral scroll, regardless of which axis was marked (grade 3.7 and 3.6). Vertically oval discs showed significantly reduced scrolling (grade 1.2) compared to horizontally oval discs (grade 3.5). Narrow strips of DM showed a similar scrolling pattern. Immunohistology showed no difference in any of the parameters examined, along the two axes or from center to periphery. Conclusion: DM scrolls primarily along the horizontal axis. Vertically oval DM samples show minimal scrolling, which can be an advantage in DMEK. The differential scrolling is not determined by the distribution of elastin.