Cleavage plane after liquid-bubble preparation of Descemet's membrane

Purpose To investigate the ultrastructure of the cleavage plane of human cornea after liquid‐bubble‐prepared tissue for Descemet's membrane endothelial keratoplasty (DMEK). Methods Experimental study with scanning electron microscopy (SEM) and block‐face SEM of 18 corneal specimens. Fresh human research donor corneoscleral discs (n = 12) were prepared with liquid‐bubble technique or examined as untreated controls (n = 3). In addition, Descemet's membrane samples, n = 3, were obtained in DMEK surgery. Results The cleavage plane after liquid‐bubble Descemet's membrane (DM) preparation was consistently located between interfacial matrix and posterior stromal collagen lamellae, providing a largely smooth surface exposing the amorphous interfacial zone without any significant amounts of adherent stromal remnants. No demarcation of a distinct pre‐DM layer could be detected. Conclusion The DMEK graft preparation performed by liquid‐bubble technique showed a smooth cleavage plane and could not reveal any demarcation of a distinct pre‐DM layer.