Effects of temperature and fluid media on the scroll width size of the Descemet’s membrane endothelial keratoplasty (DMEK) donor graft

Abstract

AimOur study was conducted to evaluate whether higher temperature leads to increased – or wider – scroll widths of the Descemet’s membrane endothelial keratoplasty (DMEK) donor graft.PurposeTo investigate the effects of temperature and fluid media on the DMEK donor graft scroll widths.Materials and methodsThis research work was a laboratory investigation. Baseline cell count was taken via specular microscopy for the donor corneas at room temperature (20°C–25°C). The endothelium sides of the donor corneas were stained with Trypan Blue Solution 0.4% for 30 s, and the Descemet’s membranes were stripped. The DMEK donor grafts were placed into three different fluid media – Optisol®, Balanced Salt Solution (BSS), and BSS PLUS® (BSS Plus). The DMEK donor grafts were then transferred into cold temperature (4°C) for 60 min, after which the donor grafts’ scroll widths were examined and measured. The donor grafts were then warmed in the incubator and brought to physiological temperature (35°C–37°C), and their scroll widths were examined and measured again.ResultsIn 30 measurements of ten tissues across three temperature and fluid conditions, the average scroll width measured 1.73 mm, ranging from 1.1 to 2.9 mm. In a mixed linear model, the scroll widths increased with temperature (P=0.02). There was no significant difference in scroll widths among the three solutions (P=0.84, mixed linear model).ConclusionWe observed an increase in DMEK donor graft scroll widths with higher temperatures. The usage of BSS Plus as media solution could also lead to smaller DMEK donor graft scroll widths, compared with BSS, but our study does not establish this.

Scrolling of the Donor Cornea in Dependence of Temperature and Osmolarity for Descemet Membrane Endothelial Keratoplasty

“…Während im Labor durch Degradierung der elastischen Fasern der Spenderlamelle mit Elastase die Rollneigung aufgehoben werden konnte [8], ist die klinische Anwendung der Elastase fraglich. Hinweise dafür, dass auch Temperaturunterschiede einen Einfluss auf die Transplantatrolle haben, fanden Koo et al in einer kleinen Fallserie mit je 3 Spenderlamellen [9].…”

“…Die Ergebnisse widersprechen damit der Untersuchung von Koo et al, die bei steigender Temperatur eine Zunahme des Transplantatrollen-Durchmessers beobachteten [9]. Da methodisch ähnlich vorgegangen wurde, bleibt der Grund hierfür unklar.…”

The Cologne-Mecklenburg-Vorpommern DMEK Donor Study (COMEDOS) — design and review of the influence of donor characteristics on Descemet membrane endothelial keratoplasty (DMEK) outcome

“…Also, it has been postulated that donor lens status influences the outcome of the DMEK surgery [ 11 ]. Another interesting aspect is the role of the culture media on endothelial cell viability and its effect on the actual scroll width during surgery [ 12 ]. However, the previous studies include either a small number of eyes or only present short-term results.…”

Confounding factors influencing the scroll width of Descemet membrane endothelial keratoplasty graft

“…Type (hypothermic or organ culture), composition, storage temperature, days and in particular, storing DMEK tissues at higher temperature have shown increased scroll width. [ 5 ] Composition of DM. In relation to tissue's elastic properties, impact of storage media and conditions of collagen and elastin in the banded and non-banded zones of DM has also been reported to have an impeding effect on DMEK scrolling and unscrolling.…”

“…Type (hypothermic or organ culture), composition, storage temperature, days and in particular, storing DMEK tissues at higher temperature have shown increased scroll width. [ 5 ]…”