Eye-bank preparation of endothelial tissue

Abstract

Purpose of review Eyebank preparation of endothelial tissue for keratoplasty continues to evolve. While eye bank personnel have become comfortable and competent at Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) tissue preparation and tissue transport, optimization of preparation methods continues. Surgeons and eye bank personnel should be up to date on the research in the field. As surgeons transition to Descemet Membrane Endothelial Keratoplasty (DMEK), eye banks have risen to the challenge of preparing tissue. Eye banks are refining their DMEK preparation and transport techniques Recent findings This article covers refinements to DSAEK tissue preparation, innovations to prepare DMEK tissue, and nuances to improve donor cornea tissue quality. Summary As eye bank supplied corneal tissue is the main source of tissue for many corneal surgeons, it is critical to stay informed about tissue handling and preparation. Ultimately the surgeon is responsible for the transplantation, so involvement of clinicians in eye banking practices and advocacy for pursuing meaningful research in this area will benefit clinical patient outcomes.

Risk Factors for Eye Bank Preparation Failure of Descemet Membrane Endothelial Keratoplasty Tissue

“…6 Possible reasons include the challenges associated with preparing and handling the delicate graft tissue and lack of standardization of DMEK graft preparation by both surgeons and eye banks. 7-9 Regarding the latter issue, knowledge of possible risk factors for failure in DMEK donor tissue preparation could provide both eye banks and corneal surgeons with information that would allow better selection of corneas to use for this procedure. 7 …”

Seven‐day storage of pneumatically dissected Descemet's endothelial grafts with and without Dua's layer

“…Several techniques had been suggested for preparing DE grafts with or without Dua's layer from donor corneas (Boynton & Woodward ), of which pneumatic dissection was performed by different methods (Studeny et al. ; Venzano et al.…”

“…). However, DMEK is not widely adopted due to the requirement of high surgical skills for both harvesting and transplanting the donor endothelium (Boynton & Woodward ; Salvalaio et al. ).…”

The structure and evolution of eye banking: a review on eye banks’ historical, present, and future contribution to corneal transplantation

“…75 DMEK has been slowly accepted due to the associated challenges of preparing and handling the delicate graft tissue. 76 Different techniques have been developed to isolate thin endothelium and overlying DM, including peeling, 77 pneumatic dissection, 76 and femtosecond lasers (FSLs). 78 Peeling involves an initial incision into corneal endothelium and then gently stripping DM from the overlying stroma with forceps, leaving a sheet of DM and intact underlying endothelial monolayer.…”

“…77 Pneumatic dissection separates DM from the stroma by injecting air into the paracentral cornea, thus creating a dissection plane between DM and the stroma. 75,76 Recent studies modifying this technique have also reported use and advantages of a liquid bubble for initial dissection. 79 In comparison studies, peeling and pneumatic dissection appear to obtain equal-quality DM and endothelial cell loss.…”