Measuring Endothelial Cell Loss on DMEK Grafts After Transplantation in Human Cadaveric Whole Eyes: Description of the Technique and Pilot Study

Tran, Khoa D.; Alabi, Rolake O.; Odell, Kelly; Dye, Philip K.; Downes, Kenneth; Sáles, Christopher S.

doi:10.1097/ico.0000000000001602

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…Although ECL at 6 months postoperatively can be as high as 30% to 40%, reducing ECL before graft transplantation is critical for providing patients with the best possible visual prognosis. 22 Studies in the literature using live cell staining to quantify ECL indicate a wide range, from 7% to 37%, depending on the preparation technique. 7,18,20,23,24 The average ECL of DescePrep-processed tissues evaluated similarly was 7.9%, which may allow for clinical utility and is at the lower end of literature reports for conventional manual dissection, pneumodissection.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Efficacy, Efficiency, and Cell Viability of a Novel Descemet Membrane Endothelial Keratoplasty Graft Preparation Device, DescePrep, in Nondiabetic and Diabetic Human Donor Corneas

Solley¹,

Berges

Diaz³

et al. 2021

Cornea

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The purpose of this study was to evaluate the safety, efficacy, and efficiency of a Descemet membrane endothelial keratoplasty (DMEK) graft preparation device, DescePrep, through measurement of graft viability, yield, and preparation time in both healthy and diabetic (high-risk) donor eyes.Methods: Twenty nondiabetic and 10 diabetic donor corneas were processed using DescePrep, which standardizes the liquid bubble technique. Corneas were stained with trypan blue and then processed. Cell counts through specular microscopy, optical coherence tomography imaging, and slit-lamp analysis were used for the evaluation of graft separation and viability in 5 nondiabetic corneas. The remaining 25 corneas (15 nondiabetic and 10 diabetic) were evaluated for preparation success rate and processing time. Ten corneas (5 nondiabetic and 5 diabetic) were randomly selected for further evaluation of global cell loss through staining.Results: Ninety-seven percent of corneas (29 of 30) were prepared successfully with DescePrep. The average preparation time was 2.83 6 1.8 minutes. There was no significant difference in the time of preparation between the nondiabetic and diabetic groups (P = 0.077). The overall average cell death after processing was 7.9% 6 3.7% for all corneas. There was no significant difference in cell viability between diabetic and nondiabetic tissues after Desce-Prep processing (P = 0.769). Conclusions: DescePrep is a new DMEK preparation techniquethat can process both nondiabetic and diabetic donor corneas at high yields in minutes. High-yield preparation of diabetic corneas may offer eye banks access to a larger donor pool, which is important because the demand for DMEK grafts continues to rise worldwide.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Efficacy, Efficiency, and Cell Viability of a Novel Descemet Membrane Endothelial Keratoplasty Graft Preparation Device, DescePrep, in Nondiabetic and Diabetic Human Donor Corneas

Solley¹,

Berges

Diaz³

et al. 2021

Cornea

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“…One possible explanation for our results compared to prior studies is that familiarity with the DMEK injection technique has been shown to influence the amount of endothelial cell loss. [ 24 ] The abovementioned studies were performed by surgeons experienced with the injection technique; in our study, an eye bank technician who was naïve to the three injectors performed the stripping and injection of the grafts. The lack of prior experience likely resulted in a higher rate than expected of endothelial loss with the modified Jones tube compared with experienced users.…”

Section: Discussionmentioning

confidence: 99%

Comparing the effect of three Descemet membrane endothelial keratoplasty injectors on endothelial damage of grafts

Shen

Fox²,

Johnson³

et al. 2020

Indian J Ophthalmol

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Purpose: Various injectors are commercially available for Descemet membrane endothelial keratoplasty (DMEK) but not all injectors have been studied for endothelial damage of grafts. The aim of the study was to compare endothelial damage in pre-stripped DMEK tissue from three clinically used injector devices: the modified Jones tube, the STAAR intraocular (IOL) injector, and the Geuder glass cannula in a laboratory setting. Methods: Twenty-four human donor corneas were used for this study, eight for each study arm. Each endothelial graft was pre-stripped, trephined to 8.0 mm diameter, then loaded into either the modified Jones tube, the STAAR IOL injector, or the Geuder glass cannula by an eye bank technician who had no prior experience with any of the injectors. Grafts were then ejected, stained with Calcein acetoxymethyl (AM), and quantitatively analyzed using FIJI image software. The primary outcome was the percent of endothelial damage from injector loading and injection. Donor demographics were analyzed using Fisher’s exact test. The percentage of endothelial cell loss was compared across groups using the Kruskal–Wallis test. Results: The mean percent of endothelial damage from after injection of the graft was 37.8% (±SD 12.2%) for the modified Jones tube, 37.0% (±SD 13.9%) for the STAAR IOL injector, and 23.5% (±SD 5.1%) for the Geuder cannula ( P = 0.008). Conclusion: DMEK injectors contribute to intraoperative endothelial damage of transplanted grafts. The Geuder glass cannula may offer increased ease of use and less endothelial damage compared to the modified Jones tube or STAAR IOL injector for the novice user in early cases.

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“…All these effects contribute to the development of organ dysfunction and death (18). After intraoperative operation, the ECs were damaged, and the body produced stress response and in ammatory factors (19). Therefore, sCD40L level was also increased after operation in patients with non-sepsis.…”

Section: Discussionmentioning

confidence: 99%

Persistently higher serum sCD40L levels are associated with mortality in septic patients

Liang

Zhu

Sun

et al. 2020

Preprint

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Abstract Background Soluble CD40 ligand (sCD40L) exhibits proinflammatory and procoagulant effects. Recent data indicated that sCD40L plays a significant role in septic patients. The aim of the present study was to determine sCD40L changes in surgical patients without sepsis (SWS) and in surgical sepsis patients (SS) during the first three days at Intensive Care Unit (ICU) admission, and to observe the association between sCD40L and mortality. Methods Time changes in sCD40L levels were assessed for 3 days after ICU admission in 49 patients with SS and compared with 19 SWS. Serum sCD40L concentration was detected by ELISA. Survival at 28-days was used as the endpoint. Results SS had significantly higher sCD40L levels than SWS and control patients. Advanced age (P = 0.023) was observed in the group of nonsurviving patients compared with surviving SS. We observed an association between sCD40L levels ≥ 1028.75 pg/ml at day 2 and 28-days mortality (odds ratio = 7.888; 95% confidence interval = 1.758 to 35.395; P = 0.007). Conclusions Septic patients show persistently higher circulating sCD40L levels in the first three days at ICU admission, and it is likely that sCD40L on the day 2 may have a predictive value; thus, serum sCD40L could be used as a reliable biomarker and therapeutic target in sepsis.

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Measuring Endothelial Cell Loss on DMEK Grafts After Transplantation in Human Cadaveric Whole Eyes: Description of the Technique and Pilot Study

Abstract: Our proof-of-principle experiment shows that this imaging approach enables quantification of ECL caused by different instruments and surgical techniques after graft implantation. We have used this method to visualize the learning curve of 1 surgeon when learning a new surgical technique.

Cited by 8 publications

References 35 publications

Evaluation of Efficacy, Efficiency, and Cell Viability of a Novel Descemet Membrane Endothelial Keratoplasty Graft Preparation Device, DescePrep, in Nondiabetic and Diabetic Human Donor Corneas

Evaluation of Efficacy, Efficiency, and Cell Viability of a Novel Descemet Membrane Endothelial Keratoplasty Graft Preparation Device, DescePrep, in Nondiabetic and Diabetic Human Donor Corneas

Comparing the effect of three Descemet membrane endothelial keratoplasty injectors on endothelial damage of grafts

Persistently higher serum sCD40L levels are associated with mortality in septic patients

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