Eyeworld

EW CORNEA 62 August 2018 grafting in lieu of standard EK in pa- tients with FECD [because it] allows significant use of such tissue, which would otherwise have been discard- ed." The graft size is also smaller, the study authors said, which means there's a possibility that multiple grafts could come from one donor. Dr. Mehta said there is a big ad- vantage in having the patient's own cells in these cases vs. donor tissue because it allows complete cessation of topical steroids. "There is no rejection at all since it's your own cells; even with DMEK where rejection is uncom- mon, this is an even lower risk," he said. The DM is made acellular by putting the donor tissue through two cycles of freeze-thaw, Dr. Mehta explained. A soft-tip silicone spatula is used to gently remove the donor tissue's endothelial cells without damaging the basement membrane. The DM is then stripped similarly to a standard DMEK tissue preparation. Overall, Dr. Mehta said the results of DMT have been good, but more cases are needed to better understand the longer-term benefits. Patients are limited at this point, he said, to those who are younger than 60 years old and who have a healthy paracentral corneal endothelium. In terms of the surgical procedure, Dr. Mehta said it's similar to a standard DMEK, but he finds it somewhat easier. EW References 1. Nanavaty MA, et al. Endothelial keratoplasty versus penetrating keratoplasty for Fuchs endothelial dystrophy. Cochrane Database Syst Rev. 2014 Feb 14:CD008420. 2. Borkar DS, et al. Treatment of Fuchs endothelial dystrophy by Descemet stripping without endothelial keratoplasty. Cornea. 2016;35:1267–73. 3. Okumura N, et al. Inhibition of TGF-beta signaling enables human corneal endothelial cell expansion in vitro for use in regenerative medicine. PLoS One. 2013;8:e58000. 4. Soh YQ, Mehta JS. Regenerative therapy for Fuchs endothelial corneal dystrophy. Cornea. 2018;37:523–527. Editors' note: Dr. Mehta has no finan- cial interests related to his comments. Contact information Mehta: jodmehta@gmail.com Scanning electron microscopy shows preparation of the cell-free Descemet's membrane for transplant graft. Source (all): Jodhbir Mehta, MD First-in-patient continued from page 60 Slit lamp photo taken at 1 year following acellular Descemet's membrane transplant showing a clear cornea

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