Endothelial Cell Viability of Nonscrolled “Endo-Out” Preloaded Descemet Membrane Endothelial Keratoplasty Graft

Abstract

Purpose: The purpose of our paper is to report on the endothelial viability of a preloaded Descemet membrane endothelial keratoplasty (DMEK) graft that was found to be in a fully opened, nonscrolled configuration in the glass cannula. Methods: Case Report. Results: The preloaded DMEK graft was found to be in an opened, nonscrolled configuration with the endothelial side facing outward in the micro Weiss glass cannula when the preloaded system was visualized in the operating room. As the opened graft was noted to be in a relatively immobilized state against the cannula wall, the decision was made to decline usage for transplantation and the tissue was returned to the eye bank for further assessment of endothelial viability. The DMEK graft underwent specular microscopy and Trypan Blue staining for cell damage assessment. The results demonstrated viable endothelial cells and the suitability of the DMEK graft for transplantation. Conclusions: We herein demonstrate that despite the DMEK graft being in a fully opened, nonscrolled configuration in the preloaded glass cannula, with the endothelial side facing outward, the endothelial cells were found to be viable. The evaluation and assessment of the DMEK graft were determined to be suitable for transplantation. We demonstrate that surgeons may likely accept such grafts with confidence.