Related Experiment Video
Updated: Jul 2, 2026
Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
Descemet-stripping automated endothelial keratoplasty: insertion using a novel 40/60 underfold technique for
Edwin S Chen1, Mark A Terry, Neda Shamie
1Devers Eye Institute, Portland, OR 97210, USA. eschen37@hotmail.com
Purpose:
To describe a technique for insertion of an asymmetrically folded donor graft to minimize endothelial damage during Descemet-stripping automated endothelial keratoplasty.
Methods:
The tissue is folded in a 40/60 underfold rather than the commonly used 60/40 overfold. It is then grasped with the insertion forceps by using a prone hand position. The hand is rotated clockwise until it is supine, bringing the 60% side of the fold anteriorly, and then the tissue is inserted into the anterior chamber.
Results:
In 112 eyes, conventional 60/40 overfold insertion technique resulted in a 36% loss in endothelial cell density at 6 months. In 36 eyes, the new 40/60 underfold technique results in a 26% cell loss. This difference of 10% was statistically significant (P = 0.001).
Conclusions:
This simple modification to a commonly used folding technique reduces trauma to the exposed peripheral endothelium in a 60/40 overfolded "taco," which is due to contact with the donor trephine block or other surface. It is a slight modification to a commonly used technique for graft insertion and can be easily implemented to reduce postoperative endothelial cell loss.
