Clinical Outcomes of Descemet Membrane Endothelial Keratoplasty Using Eye Bank–Prepared Tissues

Abstract

DMEK using eye bank-prepared tissue achieved outcomes comparable to those reported for DMEK using surgeon-prepared tissue.

Organ-cultured, prestripped donor tissue for DMEK surgery: clinical outcomes

“…Our findings are also in good agreement with recent clinical case series suggesting that prestripped DMEK grafts from cold-stored corneas (ie, short-term culture) showed clinical outcomes similar to those reported previously for grafts stripped on the day of surgery 7 9. Another study by Feng and coworkers performed direct comparison of prestripped tissue with grafts prepared on the day of surgery 10.…”

“…Most other reports of in vitro studies13 and clinical results7 9 19 (with the exception of the study by Feng et al 10) used a technique in which DM is only partially stripped, like in our case, and is then returned to culture lying flat on the stromal bed. Here, cell loss at 6 months after transplantation was reported as 26%,7 30.5%9 or 9.9% 19. Feng et al 10 report endothelial cell loss of 29% at 3 months following transplantation of completely prestripped tissue.…”

“…The findings from in vitro studies suggest that prestripping for DMEK may cause somewhat more endothelial cell damage than precutting for DSAEK 13. Nonetheless, good clinical outcomes were reported from clinical reports assessing prestripped DMEK tissue from cold-stored corneas 7 9. While eye banks in North America preserve donor corneas at 2–8°C for a maximum of 7–14 days, European eye banks rely mostly on organ culture at 28–37°C, which allows storage up to 4 weeks 14.…”

Rate and Localization of Graft Detachment in Descemet Membrane Endothelial Keratoplasty

“…[6][7][8][9][17][18][19] Persistent graft detachment 4 weeks postoperatively and after rebubbling is much lower (10%-15.8%) because especially smaller peripheral partial graft detachments reattach spontaneously and treatment was performed. [6][7][8][9][17][18][19] Reported rebubbling rates, however, differ vastly (3.0%-73.8%) presumably because of the different treatment regimens. 5,6,17,19,20 Some surgeons prefer early intervention in case of graft detachment, whereas others choose to intervene later.…”

Outcomes of Descemet Membrane Endothelial Keratoplasty in Patients With Previous Glaucoma Surgery

“…Donor corneal preparation and the surgical technique of DMEK have been described in detail previously 22 and did not differ among the three groups. The donor graft was unfolded with the use of a “touch, no touch” technique in which a 30-gauge cannula was used to manually unfold the Descemet membrane (DM) scroll on the DM side without touching the endothelium.…”