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adrian dokey, winston chamberlain, Julie Marie Schallhorn, Khoa D. Tran; Endothelial Cell Loss Due to Graft Injector Method in Descemet’s Membrane Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5264. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Various methods are available for introducing a Descemet’s membrane endothelial keratoplasty (DMEK) graft into the anterior chamber, and there is little published data comparing the endothelial cell loss among commercially available injectors. In this study, we evaluate the endothelial cell loss among three DMEK injector methods: the modified Jones tube, the Viscoject closed intraocular lens (IOL) insertion system, and the Dutch Ophthalmic Research Center (DORC) curved glass pipette.
To detect a 10% difference in endothelial cell loss among groups, nine DMEK grafts were required in each study arm. Trained eye bank technicians prepared DMEK grafts, then investigators loaded each graft into one of the three devices, injected it onto a bed of dispersive viscoelastic (Viscoat), and unfurled it with additional viscoelastic. Calcein AM staining was applied for 20 minutes, photomicrographs were taken, and image segmentation was performed to distinguish between live and damaged endothelial cells. Areas of live versus damaged cells were compared to determine percentage of endothelial cell loss in each graft. Two-tailed t-tests were performed to compare the extent of endothelial cell loss among groups.
Nine grafts were prepared in each of the three study arms. Endothelial cell loss ranged from 21 to 35% in the modified Jones tube group, from 21 to 47% in the Viscoject group, and from 18 to 43% in the DORC pipette group. Mean percentage of endothelial cell loss was 27% (+/- 5%) for the modified Jones tube group, 32% (+/- 8%) for the Viscoject group, and 31% (+/- 9%) for the DORC pipette group. No statistically significant difference was detected among any of the three groups (Jones vs Viscoject p=0.3, Jones vs DORC p=0.3, Viscoject vs DORC p=0.7).
Graft preparation and injection results in an average endothelial cell loss of around 30% with these devices. Despite differences in injector materials, dimensions and techniques, no significant difference in endothelial cell loss was shown among the modified Jones tube, Viscoject insertion system, and DORC pipette.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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