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Rolake Alabi, Khoa D. Tran, Kelly Odell, Phillip K Dye, Kenneth Downes, Christopher S Sales; Measuring endothelial cell loss in Descemet Membrane Endothelial Keratoplasty (DMEK) grafts after transplantation in human cadaveric whole eyes. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2901. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To describe a novel method for analyzing DMEK graft damage after implantation into human cadaveric donor eyes, and to compare results when performing DMEK with a surgeon’s long-established technique compared to an unfamiliar technique.
After implanting a DMEK graft and attaching it to the recipient stroma with an air bubble tamponade, the corneoscleral cap was ‘recovered’ from the cadaveric globe using standard techniques. The DMEK graft was stained with Calcein-AM. After staining, a 9.5 mm stromal ‘carrier button’ was punched, and the carrier and graft was transferred to a microscope slide. Grafts were imaged and analyzed using FIJI trainable segmentation. Eight DMEK grafts were implanted into previously frozen human cadaveric eyes. Four grafts were implanted using a Straiko injector and tap technique familiar to the surgeon, and four grafts were implanted using the Tan EndoGlide and ‘donor mat device’ pull-through technique new to the surgeon.
Donor graft characteristics were not significantly different between the two groups (all P>0.3). Grafts implanted using the surgeon’s routine technique showed an average endothelial cell loss (ECL) of 31 ± 4% (n=3). Grafts implanted using the technique unfamiliar to the surgeon showed an average ECL of 47%, but with a trend toward improvement (1=76%, 2=65%, 3=32%, 4=17% ECL).
Our proof-of-principle experiment show that this imaging approach enables accurate quantification of ECL caused by different instruments and surgical techniques after graft implantation. We have employed this method to visualize the learning curve one surgeon faced when learning a new surgical technique.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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