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Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
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Five-Year Endothelial Cell Density Outcomes After DMEK Using Peripherally Versus Centrally Trephinated Donor Tissue.

Samar K Basak1, Soham Basak

  • 1Cornea Department, Disha Eye Hospitals, Barrackpore, Kolkata, India.

Cornea
|July 14, 2026
PubMed
Summary

Peripheral trephination for Descemet membrane endothelial keratoplasty (DMEK-pD) shows superior long-term endothelial cell density (ECD) compared to central trephination (DMEK-cD). This simple donor preparation modification enhances graft survival without affecting visual acuity or safety.

Keywords:
5-year outcomesDMEKcentrally trephinated graftendothelial cell densityperipherally trephinated graft

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Last Updated: Jul 16, 2026

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Published on: July 22, 2022

Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Endothelial Keratoplasty

Background:

  • Corneal endothelial dysfunction necessitates keratoplasty for vision restoration.
  • Descemet membrane endothelial keratoplasty (DMEK) is a common endothelial keratoplasty technique.
  • Donor tissue preparation methods may influence graft outcomes.

Purpose of the Study:

  • To compare 5-year endothelial cell density (ECD) outcomes after DMEK using peripherally trephinated donor tissue (DMEK-pD) versus centrally trephinated donor tissue (DMEK-cD).
  • To evaluate visual acuity, complications, and graft failure rates between the two DMEK preparation techniques.

Main Methods:

  • Retrospective comparative study of 428 eyes undergoing DMEK-pD (n=205) or DMEK-cD (n=223).
  • Standardized no-touch technique used, with surgeon-prepared grafts.
  • ECD measured at 6 months and annually up to 5 years; visual acuity, complications, and secondary graft failure (SGF) recorded.

Main Results:

  • Mean ECD was significantly higher in the DMEK-pD group at all postoperative time points up to 5 years (P < 0.001).
  • Visual acuity improvement was comparable between groups (P = 0.15).
  • DMEK-pD showed better long-term ECD preservation, especially in Fuchs endothelial corneal dystrophy; SGF was more frequent in DMEK-cD (10.8% vs 5.9%, P=0.13).

Conclusions:

  • DMEK with peripheral donor tissue trephination offers sustained long-term ECD advantages over central trephination.
  • This technique does not compromise visual outcomes or safety.
  • A simple modification in donor preparation may enhance graft longevity in DMEK.