Elastin Content and Distribution in Endothelial Keratoplasty Tissue Determines Direction of Scrolling

Mohammed, Imran; Ross, Andrew R.; Britton, John O.; Said, Dalia G.; Dua, Harminder S

doi:10.1016/j.ajo.2018.07.001

Cited by 31 publications

(27 citation statements)

References 29 publications

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“…90 95-97 Donor graft insertion and unfolding Upon separation from the posterior stroma, a free-floating DM has a natural tendency to adopt a scrolled-configuration with its endothelium on its outer surface. 98 This consistent 'endotheliumout' directional scrolling of DMEK graft tissues has been attributed to the elastin distribution within the DM-anterior dense band of elastin in the DM gives rise to a greater elasticity in its anterior compared to its posterior surface. 98 It makes intracameral graft unfolding one of the most technically demanding stages in DMEK surgery.…”

Section: Donor Graft Harvestingmentioning

confidence: 90%

“…98 This consistent 'endotheliumout' directional scrolling of DMEK graft tissues has been attributed to the elastin distribution within the DM-anterior dense band of elastin in the DM gives rise to a greater elasticity in its anterior compared to its posterior surface. 98 It makes intracameral graft unfolding one of the most technically demanding stages in DMEK surgery. In particular, scrolls formed are often tighter in younger donors, and thus unfolding is thought to be even more challenging in these circumstances.…”

Section: Donor Graft Harvestingmentioning

confidence: 90%

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Evolution of therapies for the corneal endothelium: past, present and future approaches

2020

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Corneal endothelial diseases are leading indications for corneal transplantations. With significant advancement in medical science and surgical techniques, corneal transplant surgeries are now increasingly effective at restoring vision in patients with corneal diseases. In the last 15 years, the introduction of endothelial keratoplasty (EK) procedures, where diseased corneal endothelium (CE) are selectively replaced, has significantly transformed the field of corneal transplantation. Compared to traditional penetrating keratoplasty, EK procedures, namely Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), offer faster visual recovery, lower immunological rejection rates, and improved graft survival. Although these modern techniques can achieve high success, there are fundamental impediments to conventional transplantations. A lack of suitable donor corneas worldwide restricts the number of transplants that can be performed. Other barriers include the need for specialized expertise, high cost, and risks of graft rejection or failure. Research is underway to develop alternative treatments for corneal endothelial diseases, which are less dependent on the availability of allogeneic tissues – regenerative medicine and cell-based therapies. In this review, an overview of past and present transplantation procedures used to treat corneal endothelial diseases are described. Potential novel therapies that may be translated into clinical practice will also be presented.

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Section: Donor Graft Harvestingmentioning

confidence: 90%

Section: Donor Graft Harvestingmentioning

confidence: 90%

Evolution of therapies for the corneal endothelium: past, present and future approaches

2020

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“…We note that in this study by Mohammed et al 1 a band of homogenous elastin immunofluorescence was identified above Descemet's membrane. We would be interested to know if the authors examined the elastin concentration between the posterior peripheral and central regions and, if so, were any differences detected?…”

supporting

confidence: 44%

“…We welcome the recent publication by Mohammed et al 1 that demonstrates the surgical implications of the corneal elastic system in scrolling in endothelial keratoplasty. We have pioneered the characterisation of the corneal elastic system in normal human 2 , keratoconic 3 corneas and in knock-out mouse models of Marfan's Syndrome.…”

mentioning

confidence: 89%

Elastin Content and Distribution in Endothelial Keratoplasty Tissue Determines Direction of Scrolling

Lewis¹,

White

Feneck³

et al. 2019

American Journal of Ophthalmology

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“…Zusätzlich zu Verbesserungen der Operationstechnik wäre es daher attraktiv, das Verhalten der Spenderlamelle aktiv zu beeinflussen und zu standardisieren. Mohammed et al zeigten 2018, dass die Rollung der Spenderlamelle durch Elastase komplett aufgehoben werden kann [8]. Eine komplette Degradation der Elastinfasern erachten wir im Hinblick auf eine langfristige Transplantatanlage jedoch als unvorteilhaft.…”

Section: Ergebnisseunclassified

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

Gruber

Reinhard

Wacker

et al. 2020

Klin Monbl Augenheilkd

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Background After preparation of a graft for Descemet membrane endothelial keratoplasty (DMEK), the diameter of the graftʼs scroll varies significantly. In particular, narrow scrolls may complicate DMEK surgery. In this study we investigated how temperature, osmolarity, and deswelling of the donor tissue influence scrolling diameter. Material and Methods In this study we examined donor corneas that could not be used for transplantation. The diameter of the DMEK donor scrolls was measured after graft preparation by reflected light microscopy under different conditions: (1) The diameter of the roll was measured in Ringerʼs solution at temperatures of 5 °C, 24 °C and 35 °C. (2) To study the effect of different culture conditions we used 6% dextran-containing medium for 10 min, 20 min, 16 h and 24 h, and hyper- and hypoosmolar fluids (5% NaCl or aqua dest) for 5 min each. Results The median donors age was 62 years. The median endothelial cell density of the donor corneas was 1679 cells/mm2. The median diameter of the DMEK scroll was 1.35 mm in Ringerʼs solution at 24 °C (IQR, 1.04 – 1.89). In Ringerʼs solution at different temperatures, the scrolling diameter changed between 0.02 mm and 0.29 mm. The change in osmolarity resulted in a difference of 0.02 mm to 0.46 mm. Deswelling with dextran resulted in a change of scrolling diameter between 0.02 mm and 0.09 mm. Summary In this experimental case series, the diameter of the DMEK scroll did not change due to changes of temperature, osmolarity or deswelling. Influencing the graftʼs scroll to standardize and simplify the DMEK surgery remains an interesting goal for future studies.

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Elastin Content and Distribution in Endothelial Keratoplasty Tissue Determines Direction of Scrolling

Abstract: This pattern of elastin distribution in DM explains why DMEK and PDEK tissues always scroll with the EC outside. This behavior is not influenced by the EC. High elastin content and uniform distribution in the PDL suggest a structural difference from the posterior stroma.

Cited by 31 publications

References 29 publications

Evolution of therapies for the corneal endothelium: past, present and future approaches

Evolution of therapies for the corneal endothelium: past, present and future approaches

Elastin Content and Distribution in Endothelial Keratoplasty Tissue Determines Direction of Scrolling

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

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