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Kristina Spaniol, Mathias Roth, Christoph Holtmann, Maria Borrelli, Stefan Schrader, Gerd Geerling; Corneas from pseudophakic donors for endothelial keratoplasty - challenges and solutions for Descemet-membrane preparation. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1579.
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© ARVO (1962-2015); The Authors (2016-present)
This experimental study investigated the influence of the donor lens status on the difficulty of graft preparation for Descemet-membrane endothelial keratoplasty (DMEK) when preparing the graft with a standardized no-touch technique.
A surgeon masked to the donor lens status prepared 10 research-consented, not transplantable corneas and determined the donor lens status prior to and after the preparation. Preparations were video-recorded; defects or tears in the graft were counted and measured. Death-to-extraction and organ-culture-time, lens status, preparation-difficulty, -duration, and -technique, number, length, and orientation of tears, and graft-integrity were investigated. Ten corneas were analyzed histologically by hematoxylin-eosin staining. Statistical analysis was with performed with SPSS 21.0 (IBM, Ehningen, Germany) applying p≤0.05 as level of significance.
Seven corneas (70%) were from pseudophakic and 3 (30%) from phakic donors. The surgeon determined the correct lens status in 7 cases (70%) before and in 10 cases (100%) after the preparation (p=0.007). Preparations from pseudophakic donor buttons took more time, developed more tears, and had to be prepared by “touch-technique” more often (p=0.02, p=0.04, p=0.04). Radial tears, originating from limbus-parallel adhesions and expanding to the central descemet-membrane (DM), were the reason for judging a graft unsuitable for transplantation in 2 cases. In 5 cases (72%) a “touch-technique” was used to receive a transplantable graft. All these corneas came from pseudophakic donors. A histological analysis revealed pigmented intrastromal alterations corresponding to previous corneal incisions.
The DM-preparation from pseudophakic donors is challenging. Phacoemulsification-incisions are not always macroscopically visible but may induce tissue alterations with stronger adherence of the DM to the corneal stroma. This can result in tears when pulling the DM across the adhesions and eventually render a graft unusable. Switching to a touch-technique by trephining the DM central to a tear as soon as limbus-parallel tears occur prevents central tearing. Although preparations from pseudophakic donors can be more time consuming and carry a higher risk of graft-damage, an experienced surgeon who is informed about the donor lens status can produce suitable DMEK-tissue in most cases.
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