Abstract
Purpose: :
To assess endothelial damage during the preparation and insertion of Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) donor tissue.
Methods: :
Following 1- insertion of the donor tissue through the corneoscleral rim, 2-marking on the stromal side of DSAEK tissue or 3- microkeratome excision of anterior lamellar corneal tissue (ALCT), storing one of the paired corneas with the ALCT left on the stroma, and the other with ALCT off the stroma for 24 hours, alizarin red S and trypan blue were used to identify endothelial cell damage.
Results: :
1-There were two parallel bands of damage corresponding to the insertion forceps. In addition, orthogonal wrinkles of scattered damage were seen. 2- Corneas marked with the gentian violet marking pen showed damage, limited to the area marked. 3-The endothelial damage was limited to the area of ALCT-off region, In addition, the ALCT-off donor cornea was edematous and opaque. The Descemet’s membrane of the ALCT-off samples was so loose that they easily detached from the stroma, and many Descemet’s striae were observed.
Conclusions: :
Though these three steps are just part of entire DSAEK procedure, the donor tissues showed reproducible and significant damage due to insertion forceps, gentian violet surgical marker and ALCT off storage. An understanding and avoidance of endothelial trauma in preparing and inserting DSAEK donor tissue may help to lower the rate of donor dislocation and graft failure.
Keywords: cornea: endothelium • transplantation • cornea: clinical science