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.