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Elastin content and distribution in endothelial keratoplasty tissue determines direction of scrolling

Mohammed, Imran; Ross, Andrew R.; Britton, John O.; Said, Dalia G.; Dua, Harminder S.


Imran Mohammed

Andrew R. Ross

John O. Britton

Dalia G. Said

Harminder S. Dua



Descemet membrane endothelial keratoplasty (DMEK) and pre-Descemet endothelial keratoplasty (PDEK) tissues always scroll with the endothelial cells (EC) outside. We designed a study to understand the reason for this behavior.


Experimental study.


Elastin content in Descemet membrane (DM), pre-Descemet layer (PDL), central and peripheral stroma, sclera, and trabecular meshwork were measured by the Fastin elastin assay kit. Distribution of elastin in DM, PDL, and anterior lens capsule (ALC) were examined by immunohistology. The effect of recombinant elastase enzyme and the effect of complete removal of EC and epithelial cells on the scrolling of DM and ALC, respectively, were studied.


PDL showed the highest elastin content among the different tissues studied. Elastin localized as a distinct anterior band in the DM and was uniformly distributed in the PDL demarcating the latter from corneal stroma. Enzymatic treatment of DM with elastase reversed scrolling and corresponded with degradation or disappearance of elastin. Removal of EC did not affect the direction of scrolling. ALC behaved in the same manner with regard to distribution of elastin, scrolling, and removal of epithelial cells.


This pattern of elastin distribution in DM explains why DMEK and PDEK tissues always scroll with the EC outside. This behavior is not influenced by the EC. High elastin content and uniform distribution in the PDL suggest a structural difference from the posterior stroma.

Journal Article Type Article
Publication Date Oct 31, 2018
Journal American Journal of Ophthalmology
Print ISSN 0002-9394
Electronic ISSN 1879-1891
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 194
Pages 16-25
Keywords Ophthalmology
Publisher URL!
Additional Information This article is maintained by: Elsevier; Article Title: Elastin Content and Distribution in Endothelial Keratoplasty Tissue Determines Direction of Scrolling; Journal Title: American Journal of Ophthalmology; CrossRef DOI link to publisher maintained version:; Content Type: article; Copyright: © 2018 Elsevier Inc. All rights reserved.


This file is under embargo until Jul 17, 2019 due to copyright restrictions.

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