June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
DMEK injectors with narrower lumen diameters may not directly correlate with increased endothelial cell loss
Author Affiliations & Notes
  • Matthew Kigin
    The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, United States
    Iowa Lions Eye Bank, Iowa City, Iowa, United States
  • Christopher Sales
    The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, United States
    Iowa Lions Eye Bank, Iowa City, Iowa, United States
  • Gregory Schmidt
    Iowa Lions Eye Bank, Iowa City, Iowa, United States
  • Sarah Vigmostad
    Roy J. Carver Department of Biomedical Engineering, University of Iowa College of Enginnering, Iowa City, Iowa, United States
  • Footnotes
    Commercial Relationships   Matthew Kigin None; Christopher Sales None; Gregory Schmidt None; Sarah Vigmostad None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 4356 – A0293. doi:
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    • Get Citation

      Matthew Kigin, Christopher Sales, Gregory Schmidt, Sarah Vigmostad; DMEK injectors with narrower lumen diameters may not directly correlate with increased endothelial cell loss. Invest. Ophthalmol. Vis. Sci. 2022;63(7):4356 – A0293.

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

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Abstract

Purpose : The relationship between endothelial cell loss (ECL) and DMEK injector lumen diameter remains poorly defined. We hypothesized that the LEITR glass injector, which has a narrower distal lumen compared to the Straiko glass injector, would be associated with increased ECL due to the DMEK scroll touching the walls of the narrower lumen. We further hypothesized that loading DMEK tissue into the LEITR injector through its proximal lumen, which is wider in diameter than its distal lumen, would reduce ECL compared to loading DMEK tissue through the proximal lumen.

Methods : A clinically significant difference in ECL was defined as ≥ 10%; for an alpha of 0.05, power of 0.9, and two-tailed tests, we designed the study to have 6 replicates for each comparison (LEITR vs. Straiko; LEITR narrow-lumen-loading vs. LEITR wide-lumen-loading). Surgical-grade mated corneal donor pairs were randomized to each group, prepared for DMEK by a trained technician, loaded into the injectors, expelled and flat-mounted, stained with Calcein-AM, and assessed for ECL using an inverted microscope and Fiji-ImageJ.

Results : We found no significant difference in ECL between the narrower LEITR injector and the Straiko injector (ECL Δ = 6.842% ± 5.61, p>0.05). We did not observe a significant difference in ECL between DMEK tissues that were loaded through the LEITR injector’s narrower distal lumen and tissues that were loaded through its wider proximal lumen (ECL Δ = 7.876% ± 5.38, p>0.05). No consistent pattern of cell damage was observed between any of the groups, either.

Conclusions : Data from this modest sample of paired corneas suggest that narrower injector lumens may not directly correlate with increased ECL. This observation contradicts prior observations of incision size and ECL in DSAEK, a procedure that mechanically delivers the allograft into the eye rather than injects it with fluid. We hypothesize that DMEK tissue may behave as a deformable solid in a pipe and may thus be relatively insulated from the lumen walls by the no-slip condition described in Poisseuille parabolic flow. Further study is needed to test this hypothesis, which if true, would suggest that flow patterns and velocity may be more related to ECL than lumen diameter.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

The experimental design regarding both comparisons. A black arrow denotes DMEK tissue loading orientation.

The experimental design regarding both comparisons. A black arrow denotes DMEK tissue loading orientation.

 

Example comparison of the three different loading methods.

Example comparison of the three different loading methods.

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