This is the first report of the clinical use of prestained, preloaded tissue for DMEK. The characteristics and handling of the tissue were not different from those of surgeon-loaded tissue. Because punching, staining, and loading the graft intraoperatively is not necessary, the surgery time and risk of damaging donor tissue are reduced when using preloaded tissue.

It is possible to prestain and preload DMEK grafts without inducing additional endothelial cell loss. Consideration should be given to the interval between staining and surgery because stain can fade.

No abstract

DMEK and DMEK triple procedures are predictable in patients with previous refractive surgery achieving good visual results. However, refraction after the use of toric intraocular lenses may be unpredictable because of the variability in changes of the magnitude and axis of corneal astigmatism; we recommend extreme caution in the use of the toric intraocular lens in this group of patients and proper counseling for possible individual postoperative residual astigmatism.

Purpose: The aim of this study was to report 3 cases of corneal endothelial allograft rejection shortly after immunization with SARS-CoV-2 messenger RNA (mRNA) vaccines and to describe the clinical course, management, and outcomes. Methods: This is a retrospective case series. Results: Three patients presented with corneal endothelial rejection 3 weeks after the second dose of a SARS-CoV-2 mRNA vaccine: a 25-year-old woman's 8-month status post-Descemet stripping endothelial keratoplasty for a failed penetrating keratoplasty (PK) (Pfizer-BioNTech COVID-19 vaccine), a 70-year-old man's 4-year status post-PK (Pfizer-BioNTech COVID-19 vaccine), and a 45-year-old woman's 8-month status post-PK (Moderna COVID-19 vaccine). Each of the patients was on a maintenance dose of prednisolone acetate twice daily, which was increased to 4 times daily before the first dose of Pfizer-BioNTech COVID-19 vaccine in the 25-year-old woman. At the time of diagnosis of endothelial rejection, prednisolone acetate was increased to every 1–2 hours for each patient, with resolution of the rejection in the PK recipients but progression to endothelial failure in the Descemet stripping endothelial keratoplasty recipient. Conclusions: Our report provides further evidence of a potential association between mRNA vaccines and corneal allograft rejection. Contrary to prior reports, corneal endothelial rejection associated with COVID-19 vaccines may be sufficiently severe to result in irreversible graft failure despite steroid prophylaxis.