April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Pre-Descemetic Automated Endothelial Keratoplasty (PDAEK), towards an automated DMEK preparation technique
Author Affiliations & Notes
  • Mor Dickman
    University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
  • Jurriaan Brekelmans
    University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
  • Petra Steijger-Vermaat
    Euro Cornea Bank, Euro Tissue Bank, Beverwijk, Netherlands
  • Teja Wesseling
    Euro Cornea Bank, Euro Tissue Bank, Beverwijk, Netherlands
  • Friso W.F. van Marion
    Euro Cornea Bank, Euro Tissue Bank, Beverwijk, Netherlands
  • Frank Van den Biggelaar
    University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
  • Tos TJM Berendschot
    University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
  • Rudy M Nuijts
    University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
  • Footnotes
    Commercial Relationships Mor Dickman, None; Jurriaan Brekelmans, None; Petra Steijger-Vermaat, None; Teja Wesseling, None; Friso W.F. van Marion, None; Frank Van den Biggelaar, None; Tos TJM Berendschot, None; Rudy Nuijts, Gebauer Medizintechnik GmbH (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 2699. doi:
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      Mor Dickman, Jurriaan Brekelmans, Petra Steijger-Vermaat, Teja Wesseling, Friso W.F. van Marion, Frank Van den Biggelaar, Tos TJM Berendschot, Rudy M Nuijts; Pre-Descemetic Automated Endothelial Keratoplasty (PDAEK), towards an automated DMEK preparation technique. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2699.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

One of the main limitations to wide-spread adoption of Descemet Membrane Endothelial Keratoplasty (DMEK) is the lack of a standardized automated technique for graft preparation. In the current study we set out to establish a proof of concept for automated harvesting of planar pre-Descemetic (<50μm) endothelial grafts using a novel vacuum assisted microkeratome system.

 
Methods
 

Sixty-nine organ cultured human donor corneas unsuitable for transplantation were dissected using a prototype linear microkeratome system (Gebauer SLc Expert; Gebauer; Germany). Following epithelial removal, donor corneas were applanated using vacuum (600 mbar) against a porous rigid-reference-member (RRM) designed to correct for central to peripheral thickness differences in the donor cornea (figure 1). Thickness measurements were obtained by Fourier domain Anterior-Segment Optical-Coherence-Tomography (Casia SS-1000; Tomey; Japan). Endothelial cell density was determined by Trypan blue exclusion, followed by triple Hoechst-Ethidium-Calcein (HEC) labeling for pan-corneal endothelial viability assessment.

 
Results
 

Mean post-cut endothelial graft thickness measured 40 (±7) μm, significantly thinner than 50μm (p<0.05). RRM application resulted in significantly planar graft thickness profiles compared with the meniscus shape observed without RRM application (p<0.05) (figure 2). Mean post-cut endothelial cell density measured 2245 (±175) cells/mm2 with an average 70% (±10%) pan-corneal endothelial viability.

 
Conclusions
 

This study established a proof of concept for reproducible automated vacuum assisted harvesting of planar pre-Descemetic endothelial grafts with satisfactory endothelial cell density and viability, addressing many of the limitations of current mechanical microkeratomes and introducing a novel technique for endothelial graft preperation (PDAEK).

 
 
Figure 1. Gebauer SLc Expert Illustration. Vacuum assisted corneal applanation against a porous profiled rigid-reference-member (RRM), deigned to allow dissection of 30-950 μm thick planar endothelial grafts.
 
Figure 1. Gebauer SLc Expert Illustration. Vacuum assisted corneal applanation against a porous profiled rigid-reference-member (RRM), deigned to allow dissection of 30-950 μm thick planar endothelial grafts.
 
 
Figure 2. RRM Assisted Corneal Profiling. Anterior-Segment Optical-Coherence-Tomography (CASIA SS-1000; Tomey; Japan) images of 2 donor corneas prior to (upper row) and following (lower row) dissection of ∼50μm grafts with (left) and without (right) profiled rigid-reference-member (RRM) correction for central to peripheral thickness differences.
 
Figure 2. RRM Assisted Corneal Profiling. Anterior-Segment Optical-Coherence-Tomography (CASIA SS-1000; Tomey; Japan) images of 2 donor corneas prior to (upper row) and following (lower row) dissection of ∼50μm grafts with (left) and without (right) profiled rigid-reference-member (RRM) correction for central to peripheral thickness differences.
 
Keywords: 741 transplantation • 481 cornea: endothelium • 479 cornea: clinical science  
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