Novel Surgical Instruments Facilitating Descemet Membrane Dissection

Purpose: To introduce 2 new untoothed curvilinear forceps for improved dissection of Descemet membrane (DM) and comparison with the 1-point forceps technique. Methods: DMs of 16 corneoscleral rims were separated using either 1-point forceps dissection (group A) or curvilinear forceps dissection (group B). Preparation time, handling, and endothelial cell quality were analyzed. Quantification of potential damage during the preparation was achieved by staining with a viability bioassay (calcein acetoxymethyl and ethidium homodimer-1) and 4',6'-diamidino-2-phenylindole (DAPI). The average of 5 different areas per DM was considered for endothelial cell death ratios (ethidium homodimer-1-positive cells vs. DAPI-positive cells). Results: In both groups, all prepared DMs were usable for transplantation. The duration of preparation was 11.0 minutes in group A and 6.4 minutes in group B, demonstrating that the new forceps is superior in this respect (P = 0.008). The average percentage of endothelial cell death ratios (ethidium homodimer-1-positive cells vs. DAPI-positive cells) was 7.2% +/- 3.0% in group A and 3.4% +/- 2.0% in group B. A significant difference was noted (P = 0.04). Conclusions: By applying the curvilinear forceps technique, a reduced preparation time was noted. Also, final quality was higher as indicated by a significantly lower endothelial cell death ratio in group B. These technical features translate directly into both a low-level tissue wastage and a decreased preparation time with high tissue conservation.