Descemet's membrane in penetrating keratoplasties of the human eye

The response of Descemet's membrane in penetrating keratoplasty wounds was studied by light microscopy in 23 human eyes. Although only parts of the grafted areas could be sectioned in each eye, 15 splittings, full-thickness flanges, or fragmentations of Descemet's membrane were found in ten specimens. Seven of these abnormalities resulted in incarceration of Descemet's membrane into the wound. Malapposition of the wound edges was a causative factor in two additional eyes. Six of these incarcerations produced a visible stromal wound defect. Exacting surgical apposition of the stromal edges of the graft and recipient cornea can therefore be expected to reduce, but not eliminate, these healing abnormalities. Great care must be taken in cutting the graft and removing the recipient tissue to avoid stripping the tough Descemet's membrane from the overlying softer stroma with dull instruments or overlapping cuts.