Evidence map›Paper›PMID 40425832›Full record

Observational studyEye (London, England)2025

Visual and ultrastructural analysis after splitting of recipient's Descemet membrane during Descemet membrane endothelial keratoplasty.

Maximilian Friedrich, Jasper Lind, Hyeck-Soo Son, Timur Mert Yildirim, Gerd Uwe Auffarth, Victor Aristide Augustin

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Eye (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Maximilian FriedrichDepartment of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany.ORCID http://orcid.org/0009-0000-8699-4613
Jasper LindDepartment of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany.
Hyeck-Soo SonDepartment of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany.ORCID http://orcid.org/0000-0003-1065-4035
Timur Mert YildirimDepartment of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany.ORCID http://orcid.org/0000-0002-3687-5082
Gerd Uwe AuffarthDepartment of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany.
Victor Aristide AugustinDepartment of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany. Victor.Augustin@med.uni-heidelberg.de.ORCID http://orcid.org/0000-0002-6315-8484

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDuring Descemetorhexis in Descemet Membrane Endothelial Keratoplasty (DMEK), inadvertent lamellar splitting of the recipient's Descemet membrane (DM) may occur, leaving DM remnants on the posterior corneal surface. This study investigates the influence of lamellar splitting on surgical outcome as well as the histological ultrastructure of split DMs.

methodsIn this prospective, observational, single-centre cohort study 129 eyes of 102 patients were divided into two groups depending on the occurrence of intraoperative splitting. If splitting of the recipient's DM occurred, the remnants were polished via irrigation/aspiration. The primary outcome was the corrected distance visual acuity (CDVA) four months after DMEK. Secondary outcomes were central corneal thickness (CCT), thinnest corneal thickness (TCT), posterior corneal density (PCD), endothelial cell loss (ECL), and the re-bubbling rate. For histopathological analysis two removed DMs were examined using scanning and transmission electron microscopy.

resultsIntraoperative splitting occurred in 36 eyes (27.9%). The postoperative CDVA in the group with splitting (0.12 ± 0.12 logMAR) did not significantly differ from the group without splitting (0.12 ± 0.12 logMAR; p = 0.96). CCT, TCT, PCD, ECL, and the re-bubbling rate also did not significantly differ between both groups (p > 0.05). In ultrastructural analysis, the split layer had a thickness of 2 µm and showed an irregular splitting interface.

conclusionInadvertent lamellar splitting of the recipient's DM during DMEK does not have a significant impact on the visual outcome. Therefore, polishing the DM remnants intraoperatively may address this complication in sufficient manner for optimizing visual outcomes.

Indexed as

Descemet MembraneDescemet Stripping Endothelial KeratoplastyEndothelium, CornealFuchs' Endothelial DystrophyIntraoperative ComplicationsVisual AcuityAgedAged, 80 and overCorneal Endothelial Cell LossFemaleHumansMaleMicroscopy, Electron, ScanningMicroscopy, Electron, TransmissionMiddle AgedProspective Studies

Identifiers

PMID40425832
PMCPMC12274397

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.