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Eric Jennings, Nicholas Sprehe, Anup Kubal, Patrick Gore, Lynn Forest-Smith, Matthew Gray, Mitchell D McCartney; Endothelial cell viability comparison between fully peeled and simulated injected DMEK tissue. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5268. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet’s membrane endothelial keratoplasty (DMEK) is gaining popularity among the corneal surgeon population. Eye banks are beginning to provide tissue that is pre-peeled, making the initial manipulation easier and less traumatic. In this study, we investigate the viability of endothelial cells of peeled Descemet’s membrane (DM) tissue with and without manipulation.
Donor corneas not suitable for transplant were randomly assigned to the three groups (n=10). Group 1 (control) was not manipulated. Group 2 DM were trephined, peeled off completely and immediately set back down on the stromal bed soaking in Optisol GS solution. Group 3 DM were trephined, completely peeled and placed into a glass Jones tube with an attached syringe filled with sterile balanced salt solution for 10 minutes prior to being ejected back onto its original stromal bed soaking in Optisol GS solution. Endothelial cell density (ECD) was obtained from all groups with a specular microscope prior to manipulation. The tissue from all Groups were subsequently stained using a modification of Park et al. (2012). Light micrographs were taken of at least three DM areas, the cells counted (minimum of 500 cells/micrograph) and the devitalized cells stained with Trypan expressed as a percentage of the total number of cells.
Measurements of ECD were obtained in all three groups. The mean ECD in Group 1 was 2466±115.5 (SEM), 2407±136.2 for Group 2 and 2360±130.8 for Group 3. The difference in initial cell counts was not statistically significant between the Groups. The percentage of Trypan Blue stained nuclei in Groups 1, 2 and 3 were 7.5±0.72 (SEM), 11.1±1.1 and 31.1±2.8 respectively. There was a significant difference in percentage of stained nuclei between the control vs. peeled group (p<0.1) as well as significant differences between the control vs. peeled/injected and peeled only vs. peeled/injected (p<0.001).
This study confirms the significant loss of endothelial cell viability due to DMEK peeling and manipulation beyond simple ECD measurement.
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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