Preparation of pre-cut corneas from fresh donated whole globes for Descemet’s stripping automated keratoplasty: 3-year results at the Central Eye Bank of Iran

Abstract

To describe the technique and the results of the preparation of pre-cut corneas for Descemet's stripping automated endothelial keratoplasty (DSAEK) during a 3-year period at the Central Eye Bank of Iran (CEBI). The method of preparation of pre-cut corneas from donated whole globes at the CEBI is described and the frequency and percentage of pre-cut corneas prepared for DSAEK, between April 2009 and March 2012, are specified. Moreover, post-operative reports are reviewed for any complaints about using pre-cut tissues for DSAEK. Out of the 1,518 donated whole globes appropriate for DSAEK, 1,478 (97.4 %) pre-cut corneas were successfully prepared. The method of preparation failed in 40 (2.6 %) cases. Based on the eye bank post-operative reports, thickness of pre-cut tissues for DSAEK was deemed unacceptable in only 6 (0.4 %) cases prior to surgery; five of these were too thick and one was too thin. Preparation of pre-cut corneas, for DSAEK from donated whole globes, in the CEBI is a safe and easy method, with very good preservation of endothelial cells after the preparation of the pre-cut corneas and reduced risks from corneal manipulation.

Preparation and thickness profile of endothelial keratoplasty lenticules from donated whole eyes with previous photorefractive keratectomy

“…In addition to selection of PRK corneas with a high endothelial quality, another explanation for a very good endothelial rating after the microkeratome cut can be the unique technique used at the CEBI. [ 8 ] In this method, the anterior chamber of whole eyes supports the procedure, and risks from tissue manipulation and endothelial cell loss are lower.…”

“…As a safe alternative to conventional penetrating keratoplasty, Descemet stripping automated endothelial keratoplasty (DSAEK) with rapid postoperative visual rehabilitation is the most popular transplantation technique for various types of endothelial disorders. [ 1 2 3 4 5 6 7 ] Preparation of microkeratome-assisted precut endothelial lenticules from either whole eyes[ 8 ] or excised corneoscleral discs[ 9 10 11 ] in eye banks has shortened the duration of surgery as well as anesthesia. Over the last decade in Iran, like the USA,[ 12 ] there has been an increasing rate of donor tissue use in endothelial keratoplasty techniques.…”

Preparation of endothelial keratoplasty lenticules with Gebauer SLc Original versus Moria CBm Carriazo-Barraquer and Moria One-Use Plus microkeratomes

“…All the procedures were performed by an experienced eye bank technician (T. Ch), in a grade “A“ clean room. Fresh whole eyes of very good to excellent endothelial rating[ 16 ] and without flat anterior chamber were selected. The single-pass technique of different pass times (range of 15–21s) was implemented in all the cases.…”

“…Preparation of endothelial keratoplasty lenticules from fresh whole eyes by using CBm (Moria S.A., Antony, France) was performed as previously described. [ 16 17 ] Briefly, after the total removal of corneal epithelium, the whole eye was tightly wrapped in sterile gauze and secured with straight hemostat forceps. The limboscleral area was vacuumed to increase intraocular pressure.…”

“…In the Central Eye Bank of Iran, the majority of precut endothelial keratoplasty lenticules have been prepared from donated fresh whole eyes with a hand-guided CBm system. [ 16 ] However, there have been some instances in which whole eyes or corneoscleral buttons excised from whole eyes are subjected to either SLc- or OUP-automated systems. Given that there was no report on the preparation of endothelial keratoplasty lenticules from fresh whole eyes by using SLc versus CBm, and studies on the comparison between SLc and OUP systems were performed on limited numbers of cases,[ 11 12 ] this study was designed to address these issues.…”