Intrastromal descemet membrane transplantation in eyes with advanced keratoconus

Background. To report the outcomes of intrastromal Descemet membrane (DM) transplantation in corneas with advanced keratoconus. Materials and methods. Three eyes of 3 patients presented with advanced, progressive keratoconus. None of the eyes had prior UV-crosslinking or any other ocular surgery performed. All eyes had a donor DM implanted into a mid-stromal pocket under local anesthesia, and clinical outcomes were evaluated at 12 months after surgery. Results. To the best of our knowledge, this is the first report of DM transplantation performed in cases of advanced keratoconus. At 12 months after surgery, the DM graft was well positioned and barely visible within the recipient stroma, and all corneas were clear. None of the eyes showed signs of keratoconus progression throughout the follow-up period. No significant changes were observed in uncorrected (UCVA) and best contact lens corrected visual acuity (BCLCVA), central endothelial cell density (ECD), corneal thinnest point (CTP) pachymetry, and maximum keratometry values (SimK and Kmax). No early or late postoperative complications were observed. Conclusions. Intrastromal DM transplantation may potentially be an alternative to intrastromal Bowman layer transplantation in eyes with advanced keratoconus, to postpone deep anterior lamellar or penetrating keratoplasty.