June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Examining the relationship between injector lumen diameter and exposed endothelial surface area and tissue conformation of DMEK tissue scrolls
Author Affiliations & Notes
  • Yong Kam
    Ophthalmology and Visual Sciences, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Gregory Schmidt
    Iowa Lions Eye Bank, Iowa City, Iowa, United States
  • Mark A Greiner
    Ophthalmology and Visual Sciences, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
    Iowa Lions Eye Bank, Iowa City, Iowa, United States
  • Jennifer Ling
    Ophthalmology and Visual Sciences, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
    Iowa Lions Eye Bank, Iowa City, Iowa, United States
  • Christopher Sales
    Ophthalmology and Visual Sciences, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
    Iowa Lions Eye Bank, Iowa City, Iowa, United States
  • Footnotes
    Commercial Relationships   Yong Kam, None; Gregory Schmidt, None; Mark Greiner, None; Jennifer Ling, None; Christopher Sales, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 825. doi:
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    • Get Citation

      Yong Kam, Gregory Schmidt, Mark A Greiner, Jennifer Ling, Christopher Sales; Examining the relationship between injector lumen diameter and exposed endothelial surface area and tissue conformation of DMEK tissue scrolls. Invest. Ophthalmol. Vis. Sci. 2021;62(8):825.

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

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Abstract

Purpose : The relationship between Descemet membrane endothelial keratoplasty (DMEK) tissue and injector devices is important to understand, particularly as options for tissue insertion expand. We hypothesize that the outer endothelial surface area of a DMEK scroll, which is exposed to trauma during tissue injection, is reduced when the internal diameter (ID) of the distal tube is narrowed.

Methods : DMEK tissues not suitable for transplantation (n=2, 8.0mm diameter) were loaded into either a Straiko or LEITR modified Jones tube (Gunther Weiss). Tissues were ejected from the proximal to the distal end of each tube, and images were captured using optical coherence tomography (OCT, Optovue RTVue) with the tissue positioned at the distal tube. The ID at the narrowest distal tube, as well as the DMEK scroll diameter as it passed through this point, were measured using ImageJ software. Using the measured diameter of the DMEK scrolls, we calculated the outer scroll surface area assuming that DMEK tissue forms a uniform cylinder.

Results : The narrowest ID measured at the distal end of the Straiko and LEITR tubes was 1,200µm (mean, 1,237µm±35; n=3) and 860µm (mean, 905µm±45; n=3), respectively. The diameter of the DMEK scroll at the narrowest ID of the Straiko and LEITR tubes was 1,122µm (mean, 1,174µm±83; n=3) and 795µm (mean, 884µm±80; n=3), respectively. The calculated DMEK outer scroll surface area was 27.3mm2 for the Straiko and 19.7mm2 for the LEITR tube, which represents a 27.8% decrease in exposed endothelial surface area for the LEITR compared to the Straiko tube. Qualitatively, DMEK tissues do not always form a uniform cylindrical conformation in either injector and sometimes form irregular corrugations (Figure 1).

Conclusions : In this series, DMEK tissue scroll diameter decreased in order to conform to the smallest luminal diameter of the injector. Reducing the injector’s distal lumen size may result in a significant decrease in endothelial cells potentially exposed to trauma from the injector. However, tissue scroll conformation may be increasingly altered as the lumen narrows. Further studies are needed to assess the impact of lumen diameter on scroll conformation and endothelial cell loss.

This is a 2021 ARVO Annual Meeting abstract.

 

Figure 1. DMEK scroll in the distal end of a Straiko (A, B) and LEITR (C, D) modified Jones tubes demonstrating variable tissue conformation.

Figure 1. DMEK scroll in the distal end of a Straiko (A, B) and LEITR (C, D) modified Jones tubes demonstrating variable tissue conformation.

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