Intraoperative Cell Death Signs in Corneal Graft During Triple DMEK Surgery

Abstract

Purpose: To report the occurrence of cell death signs in a corneal graft during preparation for Descemet membrane endothelial keratoplasty and intraocular lens implantation (triple DMEK) in a 65-year-old woman with Fuchs endothelial dystrophy (FED) who developed graft detachment in the postoperative course with the necessity of rebubbling 2 weeks after surgery. Methods: This is a case report. Results: DMEK graft preparation was conducted by an experienced surgeon using a no-touch liquid bubble dissection method with trypan blue for staining and bubble formation. Staining was applied right before beginning the preparation and unmasked very subtle signs of apoptosis running linear radially from the periphery to the center of the graft. By the end of preparation, those areas presented as clear visible staining streets. Graft transplantation and cataract surgery were completed using a SF6 gas bubble intracamerally. In the postoperative course, the patient developed relevant graft detachment requiring rebubbling. Hereafter, the patient showed a very good and stable outcome. Conclusions: Trypan blue staining during graft preparation revealed existing apoptosis areas. The aspect of unmasking and analyzing those areas in DMEK grafts might represent an interesting approach regarding the outcome of surgery and the prediction of postoperative complications. Moreover, this case might depict an advantage of surgeon-prepared transplants since the surgeon can directly see and evaluate the apoptosis doing preparation. Further research is necessary to examine possible correlations between the extent of apoptosis and surgery outcome.