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Hussain Elhalis, Mitchell D McCartney, Nicholas Sprehe, Alexander Blandford, Matthew Gray, Lynn Forest-Smith, Patrick Gore, Anup Kubal; Analysis of a novel delivery method of eye bank prepared fully peeled endothelial DMEK tissue. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1581.
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© ARVO (1962-2015); The Authors (2016-present)
Surgeon preparation of corneal tissue for Descemet membrane endothelial keratoplasty (DMEK) has contributed to its slow adoption. Currently, eye banks are providing only partially peeled Descemet's membrane (DM), thereby not entirely eliminating risk of intraoperative tissue loss. We investigate the viability of fully peeled free floating eye bank endothelial tissue and demonstrate the use of a modified technique for cell count analysis of endothelial tissue scrolls.
Donor corneas not suitable for transplant for reasons such as sepsis and low endothelial cell counts were randomly assigned to the three groups (n=5). Group 1 (control) DM were partially peeled and placed in Optisol GS (B&L) in a viewing chamber (Krolman); Group 2 DM were partially peeled and placed in Optisol GS in a viewing chamber then packed for shipping and transported. Group 3 DM were completely peeled after trephination and placed free-floating in a bottle of Optisol-GS. The bottles were also packed for shipping and transported. Endothelial cell density (ECD) was obtained from all groups with a specular microscope before tissue preparation as well as immediately after performing a partial DM peel. Additionally, ECD was assessed using a modification of Park et al. (2012) staining technique on day 0 in group 1 and after 24 hours for group 2 and 3 to simulate time elapsed from eye bank preparation to intraoperative use.
Measurements of ECD were successfully obtained in all 15 donor corneas. The mean ECD in Group 1 pre-peel and post-peel was 2356 cell/mm2 ± 267 (SD) and 2507 cell/mm2 ± 208, respectively. For Group 2, the mean ECD pre-peel and 24 hours post partial peel with transport was 2369 cell/mm2 ± 308 (SD) and 3132 cell/mm2 ± 625 (SD), respectively. For Group 3, the mean ECD pre-peel and 24 hours free floating with transport was 2271 cell/mm2 ± 309 (SD) and 2304 cell/mm2 ± 793 (SD), respectively. The differences in ECD within the groups were not statistically significant.
This proof of concept study shows that eye bank prepared and free floating donor tissue for use in DMEK appears to be a reasonable option based on the preservation of ECD. Future studies will explore further protection of fully peeled grafts with use of pre-loading devices.
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