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Jeffrey Holiman, Julia Talajic, David Davis-Boozer, Mark Terry; Quantitative Assessment of Endothelial Cell Loss of DMEK Prepared Grafts by Eye Bank Technicians. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1695.
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To quantitatively assess the endothelial cell loss that occurs during pre-stripping of Descemet’s membrane (DM) by eye bank technicians in preparation for Descemet’s membrane endothelial keratoplasty (DMEK) surgery.
Four research corneas with endothelium suitable for transplant were selected for DMEK preparation. Each donor corneoscleral rim was mounted on a trephine and DM was scored ~ 1.0mm central to Schwalbe’s line. Cornea stained with trypan blue to visualize endothelial damage prior to stripping and to enhance visibility of free edge of DM. DM was peeled > 90 % and returned to native position. DM was trephinated, saturated with Calcein AM stain and unfolded on slide utilizing Healon. Adobe Photoshop was used to assess endothelial cell loss (ECL) following florescent photomicroscopy.
Of the four corneas attempted for DMEK preparation, four were successful. The DMEK grafts revealed a mean ECL of 17.5% (range 14 to 21%).
Corneas can be prepared for DMEK surgery by eye bank technicians and post-stripping microscopy can be performed to assess graft quality. Additionally, the risk of tissue wastage is transferred while conserving costly operating room time. Increasing demand for DMEK prepared tissue warrants further investigations regarding optimization of preparation techniques.
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