The Last 200 Surgeon-Loaded Descemet Membrane Endothelial Keratoplasty Tissue Versus the First 200 Preloaded Descemet Membrane Endothelial Keratoplasty Tissue

Abstract

Purpose: The purpose of this study was to compare the clinical outcomes from using eye bank–prepared, endothelium-out preloaded Descemet membrane endothelial keratoplasty (DMEK) tissue with those obtained with endothelium-out surgeon-loaded DMEK tissue using the same surgical technique at 1 site. Methods: This study retrospectively reviewed 400 consecutive cases of DMEK from March 2016 to April 2018. The last 200 cases using surgeon-loaded tissue were compared with the first 200 cases using preloaded tissue. Statistical analysis was performed using the Wilcoxon signed-rank test, binomial logistic regression, Kruskal–Wallis 1-way analysis of variance, Student t test, or Pearson χ2 tests. Results: Comparing surgeon-loaded versus preloaded DMEK tissue, respectively, no statistical difference was found in the mean 6-month postoperative values for endothelial cell loss (32.9% ± 18.5% vs. 29.9% ± 16.4%, P = 0.31), best corrected visual acuity (20/26 vs. 20/25, P = 0.54), or change in central corneal thickness (−14.4% ± 8.9% vs. −15.6% ± 11.7%, P = 0.43). The mean 1-year endothelial cell loss was also not significantly different (37.6% ± 17.2% vs. 33.2% ± 14.8%, P = 0.07). Overall, the rebubble rate for surgeon-loaded tissue was 17.5% and 12.5% for preloaded tissue, a statistically nonsignificant difference. Operative outcomes for mean tissue scroll tightness (1–4) and tissue unscroll time (minutes) for surgeon-loaded and preloaded tissue were similar between groups (2.4 vs. 2.2, P = 0.12 and 3.5 vs. 3.3 minutes, P = 0.50). Conclusions: Tissue that is trephinated, stained, and loaded into an injector by the eye bank and then shipped to the surgeon had no difference in clinical outcomes compared with tissue where the surgeon performs these steps. The safety and speed of using preloaded tissue should be considered by DMEK surgeons.

Clinical Outcomes of Preloaded Descemet Membrane Endothelial Keratoplasty With Endothelium Inward: A 24-Month Comparative Analysis Between Fuchs Endothelial Corneal Dystrophy and Bullous Keratopathy

“…15 One of the most common postoperative complications after DMEK include rebubbling of the graft. Although multiple studies have reported different rebubbling rates, 29,30,[33][34][35] we noted a significantly higher rebubbling rate in patients with FECD (P = 0.042) compared with those observed in BK. Such a characteristic has already been studied in DSAEK transplantation.…”

Influence of Descemet Membrane Endothelial Keratoplasty Graft Preparation Patterns on Postoperative Clinical Outcome

“…A comparative study of surgeon-loaded and eye bank preloaded tissues showed no significant difference in clinical outcome. 36 Furthermore, the effect of donor factors on the preparation is still unknown. However, there seems to be a consensus in the literature that age and comorbidities play an important role.…”

Tissue Loss, Processing Time, and Primary Graft Failure in Eye Bank–Prepared Descemet Membrane Endothelial Keratoplasty Grafts Before and After Prestripped to Preloaded Graft Transition

“…Two other reports that used eye bank-prepared preloaded tissue found no cases of PGF in over 300 cases. 19,20 A review of DMEK conducted by the American Academy of Ophthalmology found the average rate of PGF-without preloading-to be 1.7% (range: 0%-12.5%). 21 Our results, taken together with these previous reports, suggest that the frequency of PGF with eye bank-prepared preloaded DMEK tissue is similar to prestripped-only tissue.…”