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Kathrin Rossler, Bjoern O Bachmann, John Armitage, Theofilos Tourtas, Ursula Schlotzer-Schrehardt, Volker Dockhorn, Emil Hohl, Friedrich E Kruse; Experimental evaluation of the novel ENDOJECT TM injector for the implantation of Descemet’s membrane into the anterior chamber during DMEK. Invest. Ophthalmol. Vis. Sci. 2014;55(13):877.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet membrane endothelial keratoplasty (DMEK) is a method allowing the transplantation of the endothelium - Descemet’s membrane complex (EDM) without adherent corneal stroma. Apart from a glass pipette (Geuder, Germany) there is no commercially available injector system for EDM grafts during DMEK. The purpose of this study was to design a novel DMEK injector system for injecting the Descemet's membrane roll into the anterior chamber during DMEK and to assess corneal endothelial cell density (ECD) before and 24 hours after the injection process.
Eight EDMs were manually prepared from organ cultured corneoscleral buttons not suitable for transplantation as previously described. After roll formation the EDMs were loaded into a specially designed injector, the ENDOJECT TM (Medicel AG, Wolfhalden, Switzerland), and sham-injected into organ culture media (Dulbecco's Modified Eagle’s Medium). Corneal endothelial integrity was assessed by dual staining of the grafts with trypan blue and alizarin red before and 24 hours after the injection process. ECD was quantitatively evaluated using an Image analysis software (Cell^F; Olympus, Germany).
The mean ECD of the EDMs decreased from 2040 ± 159 cells/mm2 before the injection process to 1860 ± 156 cells/mm2 24 hours after the injection process. The endothelial cell loss attributed to the transfer through the graft injector was statistically not significant (p=0.16).
Our results suggest that the injection of EDM using the newly developed DMEK injector system causes only minor endothelial cell loss, indicating that ENDOJECTTM is suitable for inserting the EDM during the DMEK procedure.
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