Descemet Membrane Anterior Keratoplasty With BrightMEM Corneal Allograft: An Innovative Technique for Treatment of Nonhealing Diseases of the Ocular Surface.

PURPOSE: To describe an innovative anterior keratoplasty technique using a decellularized Descemet membrane allograft for treating nonhealing diseases of the ocular surface, and to report clinical outcomes.

METHODS

We reviewed surgeons' survey responses pertaining to the postoperative outcomes of Descemet membrane anterior keratoplasty (DMAK) surgeries using BrightMEM (Brightstar Therapeutics; Lexington, KY) corneal allografts, which were placed during a 3-year period. Data were excluded for cases with less than 60 days of follow-up or no evidence of underlying ocular surface disease. Complete epithelialization rates, mean healing time, and mean change in visual acuity were assessed.

RESULTS

Outcomes are reported for 99 cases, performed by 15 surgeons across the United States. Complete epithelialization occurred in 84.8%, with a median healing time of 28.0 days. Healing rates and median healing time were 89.4% and 30.0 days for subtotal limbal stem cell deficiency cases (n = 47); 78.0% and 34.0 days for persistent epithelial defect cases (n = 41); and 79.5% and 30.5 days for neurotrophic keratopathy cases (n = 44). Graft retention was 91.9%. Among patients observed for more than 6 months (n = 35), complete healing was achieved in 97.1%. Nineteen patients (33%) reported pain preoperatively, and all reported improvement or resolution; the mean pain scores decreased from 5.47 preoperatively to 0.84 at follow-up. Visual acuity improved in 52.6% of cases. No infectious complications attributable to the tissue were reported.

CONCLUSIONS

DMAK using BrightMEM corneal allograft represents a valuable technique for treating nonhealing ocular surface diseases, providing high rates of durable epithelialization, pain reduction, visual improvement, and graft retention.