Size and shape matters: Evaluation of endothelial cell viability for preloaded Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) grafts in two different carriers

Abstract

Purpose : To examine endothelial cell loss (ECL) associated with DSAEK grafts preloaded in the Tan EndoGlide Ultrathin or a circular glass Jones tube.

Methods : Twenty-seven donor corneas (age 42-73) were pre-cut for DSAEK with a microkeratome, trephinated, and loaded into either a Tan EndoGlide or glass Jones tube. Grafts were stored in a Life4C filled Krolman viewing chamber for 24 hours and then removed from their carriers using retina forceps (Tan EndoGlide) or via ejection (Jones tube) onto a bed of calcein AM-supplemented viscoelastic. Grafts were then imaged and analyzed for ECL by FIJI segmentation. ECL was determined for DSAEK grafts in the different cohorts and statistical significance was determined using one-way ANOVA and Tukey’s post-hoc analysis.

Results : There were no significant differences in donor characteristics (including age, pre-processing endothelial cell density, death-to-preservation, lens status or diabetes status) for grafts loaded into a Tan EndoGlide or Jones tube. The EndoGlide is oval-shaped with a 3.5mm x 2.2mm opening, while the Jones tube has a 3mm diameter round lumen. ECL for grafts loaded into a Tan EndoGlide was 10.3% ± 2.3% (graft thickness: 60 – 189µm, n = 9). ECL for thin grafts (34 – 69µm, n = 9) loaded into the Jones tube was 24.0% ± 5.0%, while ECL for thick grafts (92 – 119µm, n = 9) was 34.2% ± 6.1%. ECL for grafts loaded into the Tan EndoGlide is significantly less than those loaded into the Jones tube (P<0.001). Thin grafts loaded in the Jones tube also had significantly less ECL than thick grafts loaded into the Jones tube (P<0.001).

Conclusions : The size and shape of the carrier can influence the cell viability of preloaded DSAEK grafts. The Tan EndoGlide and Jones tube differ in both internal shape and diameter. The higher ECL in the grafts loaded into the circular Jones tube was likely produced by endothelial-to-endothelial surface contact as well as excessive stromal folds inside of the carrier. Thinner grafts had less ECL when loaded in the Jones tube, but still showed characteristic patterns of cell loss along tissue folds.

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