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Updated: Dec 24, 2025
Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
Intraoperative fibrin formation during Descemet membrane endothelial keratoplasty
Matthew Benage1, Michael Korchak2, Michelle Boyce1
1Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Purpose:
To describe Descemet membrane endothelial keratoplasty (DMEK) cases complicated by spontaneous intraoperative fibrin formation.
Methods:
DMEK surgeries performed at two centers using a standardized technique were reviewed retrospectively for the occurrence of intraoperative fibrin formation. Cases were assessed for recipient medical history, donor age, best spectacle-corrected visual acuity (BSCVA), intraoperative unscrolling time, 6-month endothelial cell loss (ECL), and the course of the mate donor cornea.
Results:
In this review of 868 cases of standardized DMEK surgery with surgical peripheral iridotomy, 32 eyes of 29 patients (3.7%) were complicated by the formation of intraoperative fibrin formation, including 3 patients that developed fibrin in both eyes. Three of the 32 grafts failed (9.4%). None of the mate corneas transplanted (n = 27) developed complications related to fibrin. The donor age ranged from 51 to 75 years and recipient age ranged from 49 to 82 years (median, 66 years). Unscrolling time ranged from 1 to 105 min (median, 15 min). Nine eyes required one rebubble procedure. No eyes had vision-limiting comorbidities, and the 6-month BSCVA was ≥20/40 in all eyes. Six-month ECL ranged from 19% to 73% (median, 44%).
Conclusions:
We conclude that fibrin formation during DMEK surgery is an uncommon but important complication that can make graft manipulation more difficult, and may have deleterious effects on endothelial cell density and graft survival.
Insights
Spontaneous intraoperative fibrin formation complicates Descemet membrane endothelial keratoplasty (DMEK) in 3.7% of cases. This complication can impact graft survival and endothelial cell loss, though visual outcomes remain good.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Transplantation Immunology
Background:
- Descemet membrane endothelial keratoplasty (DMEK) is a surgical procedure for endothelial dysfunction.
- Intraoperative complications can affect graft outcomes.
- Fibrin formation is a potential complication during ocular surgery.
Purpose of the Study:
- To describe cases of DMEK complicated by spontaneous intraoperative fibrin formation.
- To analyze the incidence and impact of fibrin formation during DMEK.
- To assess graft outcomes in DMEK cases with intraoperative fibrin.
Main Methods:
- Retrospective review of standardized DMEK surgeries at two centers.
- Identification of cases with intraoperative fibrin formation.
- Assessment of patient history, donor/recipient demographics, visual acuity, endothelial cell loss, and graft survival.
Main Results:
- 3.7% of 868 DMEK cases (32 eyes) developed intraoperative fibrin formation.
- Three grafts (9.4%) failed; however, no mate donor corneas showed fibrin-related issues.
- Median unscrolling time was 15 minutes, and 6-month best spectacle-corrected visual acuity was ≥20/40 in all affected eyes.
Conclusions:
- Intraoperative fibrin formation in DMEK is an uncommon but significant complication.
- Fibrin can complicate graft manipulation and potentially affect endothelial cell density and graft survival.
- Despite challenges, visual outcomes in this cohort were generally favorable.
