June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Directional scrolling pattern of corneal endothelial grafts for Descemet membrane endothelial keratoplasty
Author Affiliations & Notes
  • Katrin Wacker
    Department of Ophthalmology, University Hospital Freiburg, Eye Center, Freiburg, Germany
  • Marianne Fritz
    Department of Ophthalmology, University Hospital Freiburg, Eye Center, Freiburg, Germany
  • Viviane Grewing
    Department of Ophthalmology, University Hospital Freiburg, Eye Center, Freiburg, Germany
  • Helena Wagner
    Department of Ophthalmology, University Hospital Freiburg, Eye Center, Freiburg, Germany
  • Daniel Zander
    Department of Ophthalmology, University Hospital Freiburg, Eye Center, Freiburg, Germany
  • Claudia Müller
    Department of Ophthalmology, University Hospital Freiburg, Eye Center, Freiburg, Germany
  • Daniel Böhringer
    Department of Ophthalmology, University Hospital Freiburg, Eye Center, Freiburg, Germany
  • Sonja Heinzelmann-Mink
    Department of Ophthalmology, University Hospital Freiburg, Eye Center, Freiburg, Germany
  • Stefan Lang
    Department of Ophthalmology, University Hospital Freiburg, Eye Center, Freiburg, Germany
  • Thabo Benjamin Lapp
    Department of Ophthalmology, University Hospital Freiburg, Eye Center, Freiburg, Germany
  • Thomas Reinhard
    Department of Ophthalmology, University Hospital Freiburg, Eye Center, Freiburg, Germany
  • Philip Maier
    Department of Ophthalmology, University Hospital Freiburg, Eye Center, Freiburg, Germany
  • Footnotes
    Commercial Relationships   Katrin Wacker, ProQR, the Netherlands (C); Marianne Fritz, None; Viviane Grewing, None; Helena Wagner, None; Daniel Zander, None; Claudia Müller, None; Daniel Böhringer, None; Sonja Heinzelmann-Mink, None; Stefan Lang, None; Thabo Lapp, None; Thomas Reinhard, None; Philip Maier, None
  • Footnotes
    Support  Program for Clinical Studies (KW) and Berta-Ottenstein Program for Clinician Scientists (KW), University of Freiburg, Germany
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 2341. doi:
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    • Get Citation

      Katrin Wacker, Marianne Fritz, Viviane Grewing, Helena Wagner, Daniel Zander, Claudia Müller, Daniel Böhringer, Sonja Heinzelmann-Mink, Stefan Lang, Thabo Benjamin Lapp, Thomas Reinhard, Philip Maier; Directional scrolling pattern of corneal endothelial grafts for Descemet membrane endothelial keratoplasty. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2341.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Heterogeneous scrolling behavior of Descemet membrane endothelial keratoplasty (DMEK) grafts complicates surgery. The impact of the donor’s posterior corneal shape on scrolling is unknown. We determined whether DMEK grafts have a preferred scrolling pattern.

Methods : This prospective observational study assessed scrolling axes of DMEK grafts relative to the donor’s eye. The eye bank randomly marked the rim of corneoscleral donor buttons during trephination. Surgeons recorded the scrolling axis relative to the eye bank marking and to the normal DMEK upside-down orientation marks but remained masked to the position of the eye bank marking. The scrolling axis was categorized as vertical (0–30°), oblique (>30–60°), and horizontal (>60–90°). Using mixed-effects models, we calculated scrolling axes and 95% confidence intervals (CI).

Results : Scrolling patterns of 171 donor corneas from 129 organ donors were determined. Median donor age was 71 years (interquartile range [IQR], 64-78); 40% were women and 16% of eyes were pseudophakic. 24% of donors had diabetes mellitus type 2. The donor graft scrolled vertically in 131 eyes (77%, 95% CI 70–82), horizontally in 22 eyes (13%), and oblique to the donor’s cornea in 18 eyes (11%). Non-vertical scrolling was more common donors with diabetes (mean axis deviation from vertical, 16°, 95% CI 4–28) and potentially among male donors (mean, 10°, 95% CI 0–21).

Conclusions : DMEK grafts have a natural scrolling tendency at the vertical axis. Anticipating this tendency could potentially help improve techniques for preparing trifolded and preloaded DMEK grafts. Scrolling axes should also be assessed as a potential risk factor for incomplete graft attachment.

This is a 2020 ARVO Annual Meeting abstract.

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