A technique to excise the descemet membrane from a recipient cornea (descemetorhexis)

To describe a technique for excision of the Descemet membrane (DM) from the recipient eye for preparation of a recipient stromal bed in posterior lamellar keratoplasty. In 10 human eye bank eyes and 3 patients, recipient eyes had a 5.0-mm scleral tunnel incision made extending 1.0 mm into the peripheral cornea at the 12 o'clock surgical position. The anterior chamber was completely filled with air, and a reflective glide was placed through the incision onto the iris, to better visualize DM. A 9.0-mm mark was made onto the corneal epithelium to outline the area from which the Descemet membrane was to be removed. With a custom-made scraper, the DM was then carefully stripped off the posterior stroma by loosening the membrane at the 6 o'clock position and pulling it toward the incision at 12 o'clock. The excised DMs were evaluated by light and electron microscopy. In all recipient eyes, DM could be easily and completely removed from the posterior corneal stroma. Microscopy showed isolated DMs without stromal tissue elements. With the technique described, DM can be excised in a controlled fashion without damaging the posterior corneal stroma, to quickly create a recipient stromal bed before implantation of a donor posterior lamellar disk in posterior lamellar keratoplasty