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Peter Bedard, Joshua H Hou; Characterization of Endothelial Cell Loss in Pre-Descemet’s endothelial keratoplasty (PDEK).. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2903. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
PDEK is a promising alternative to DMEK. Early case reports have suggested good clinical outcomes with PDEK; however, in many such cases, graft prep was done by the surgeon in the OR without formal post-processing tissue evaluation. Little is known regarding the safety of PDEK processing on endothelium. The purpose of this study was to characterize the pattern of endo cell loss after PDEK prep and to evaluate tissue factors associated with cell loss.
PDEK prep was performed on transplantable grade donor corneas by a single tech using either air or Optisol. After bubbling, tissue was evaluated with trypan blue and a real-time, live/dead assay to assess the endo. Donor age and tissue preservation time were collected. Outcomes were recorded as: 1) failure to achieve a big bubble (BB), 2) successful BB but unacceptable endo cell loss, or 3) successful BB with acceptable endo.
In total, 131 corneas were obtained and tested. In 17% (22/131) of cases, no BB was obtained. Excluding those cases, only 44.0% (48/109) had acceptable endothelium after tissue processing. There was no difference in rates of endo-related failure between the first 25% and last 25% of cases performed (p=0.38). A reticular, web-like pattern of cell loss was noted in areas of stromal hydration and type 1 BB formation. No difference was found in rates of endo-related failure between air and fluid inflation (p=0.78). Increasing donor age and decreasing tissue preservation time were associated with increased rates of successful BB with adequate endo. Endothelial cell death was associated with stromal hydration prior for formation of the BB.
PDEK processing can result in a reticular, web-like pattern of endo cell loss. Older donor tissue and tissue with shorter preservation times may be preferable for PDEK.
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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