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Matthias Fuest, Ansgar Flammersfeld, Sabine Salla, Peter Walter, Martin Hermel; Comparison of Gebauer SLc and Moria CBm ALK Microkeratomes for DSAEK lamella preparation and storage. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2698.
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© ARVO (1962-2015); The Authors (2016-present)
In this study we compared preparation accuracy, endothelial cell loss and lamellar surface structures of the hand-guided ALK Microkeratome (CBm) by Moria and the Gebauer SLc (SLc), a fully automatic preparation system, for lamellar donor preparation in Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK).
15 human donor corneas unsuitable for transplantation were dissected with 300μm CBm multiuse heads (Moria S.A., France) (n=6), or 300µm SLc (n=9) single use heads (Gebauer GmbH, Germany). Artifical anterior chamber pressure in both systems was set to 95cm H2O. The CBm passage time was kept at 5 seconds. Preparation was conducted after 21-28 days of culture in 100ml modified minimal essential medium (MEM), followed by 24-48 hours deswelling in the same medium containing 5% Dextran (CM 2). After dissection the anterior lamella (AL) was placed back on the posterior lamella (PL) and then incubated in CM2 for another 6 days. Corneal thickness (CT) was measured by pachymetry (SP-100, Tomey GmbH, Germany) and spectral domain optical coherence tomography (AS-OCT, Heidelberg Engineering, Germany) before preparation (0h) and 1 and 24 hours after dissection with AS-OCT. The endothelial cell density was evaluated at 0, 1, 24 and 144 hours. PL surface roughness was evaluated by Field Emission Scanning Electron Microscopy in cryo-mode (S4800, Hitachi Ltd., Japan) and assessed by 3 masked observers.
Pre-cut donor cornea thickness did not differ significantly measured by AS-OCT or pachymetry with a high correlation of both devices (r2=0.92, p<0.0001). One hour after preparation the AL showed a significantly higher dissection depth in CBm (417.39 ±14.55µm) than SLc (344.26 ±54.44µm, p=0.0019), with the variance of SLc being higher (p=0.047). AL and PL thickness increased slightly in the subsequent culture period in CM2. Initial and final central endothelial cell density differed between the 2 groups (CBm pre-cut=2200 ±505cells; CBm post-cut=1913 ±165cells / SLc pre-cut=2744 ±202cells; SLc post-cut=2344 ±459cells). Evaluation of the surface of the PL by cryo-electron microscopy showed comparable surface structures for both systems.
The Gebauer SLc system agrees more with the designated cutting depth than the Moria CBm. However, the variance may be higher in the automatic Slc system. Endothelial cell loss and posterior lamella surface structure were comparable.
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