Quantification and Patterns of Endothelial Cell Loss Due to Eye Bank Preparation and Injector Method in Descemet Membrane Endothelial Keratoplasty Tissues

Schallhorn, Julie M.; Holiman, Jeffrey D.; Stoeger, Christopher G.; Chamberlain, Winston

doi:10.1097/ico.0000000000000690

Cited by 31 publications

(27 citation statements)

References 20 publications

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“…Cell loss from graft preparation alone has been estimated to range from 12.4% to 28%, while tissue preparation and subsequent aspiration and injection can result in cell loss of 23% to 32%. [ 14 18 19 20 ] Our results for the Geuder glass cannula are at least comparable; for the modified Jones tube, our reported cell loss is slightly higher than the 19–32% of endothelial loss reported in the literature. [ 14 18 21 22 23 ]…”

Section: Discussionsupporting

confidence: 73%

“…compared the modified Jones tube, a glass injector with a 2.4 mm opening, to the Viscoject IOL injector (Viscoject 2.2, Medicel), a plastic injector with a 1.9 mm opening, and found no statistically significant difference in cell viability. [ 14 ] More recently, Downes et al . compared the DORC injector with a 1.4 mm opening to the modified Jones tube and found no difference in cell loss.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies comparing and quantifying endothelial cell loss between different injector methods have evaluated the modified Jones tube and IOL cartridges. [ 13 14 ] The Geuder glass injector (Geuder AC, Heidelberg, Germany) was recently introduced for the purpose of DMEK insertion but there have been no studies to date on its effect on endothelial cells. In this study, we compare the effect of three different injectors—the modified Jones tube, the STAAR IOL injector (STAAR Surgical, Monrovia, California), and the Geuder glass cannula—on endothelial cell loss in DMEK grafts.…”

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confidence: 99%

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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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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…This is an improvement over previously published rates from our CB (3.3%), [25] which likely resulted from the additional daily CB technician training. Endothelial loss between the time of tissue stripping and 6 months after grafting may have been caused by any or all of the following: trephination, [33] graft insertion into the injector, [34] donor tissue injection into the host anterior chamber, [35] the deployment procedure, [36] and postoperative air injection to treat graft detachment. [37] It has also been reported that 2 or more air injections lead to further endothelial cell loss.…”

Section: Discussionmentioning

confidence: 99%

Eye bank prepared versus surgeon cut endothelial graft tissue for Descemet membrane endothelial keratoplasty

Regnier¹,

Auxenfans

Maucort-Boulch

et al. 2017

Medicine

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The purpose of this article is to examine outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed with cornea bank (CB) prestripped tissue and surgeon stripped tissue (SST).This retrospective study examined subjects who underwent DMEK with CB or surgeon prepared tissue for Fuchs endothelial corneal dystrophy. Best-corrected visual acuity (BCVA), corneal thickness, endothelial cell count (ECC), and complications were examined before and throughout a 6-month postoperative period.Eleven CB and 22 SST subjects were included. Six months after surgery, BCVA was 20/20 or better in 36.4% of CB and 22.7% of SST subjects (P = .43). Median logMAR BCVA was 0.10 (0.00–0.20, 20/25) in group CB and 0.10 (0.10–0.30, 20/25) in group SST. Median preoperative corneal thickness was 614.0 μm (577.5–662.0 μm) and 658.0 μm (606.0–689.0 μm) in CB and SST subjects, respectively (P = .37). Six months after surgery, median corneal thickness was lower in the CB group (571.0 μm [478.0–592.0 μm]), than in the SST group (576.0 μm [531.0–607.0 μm], P = .02). At 6 months, median ECC was 1500.0 cell/mm2 (1321.5–2049.0 cell/mm2, 41% decrease) in group CB and 1403.0 cell/mm2 (972.5–2010.7 cell/mm2, 46% decrease) in group SST (P = .70). Rebubbling was required in 5 CB (45.5%) and 15 SST (68.2%) subjects (P = .39).Fuchs’ dystrophy patients have good anatomic and functional DMEK results. Similar outcomes and complication rates occurred with eye bank and surgeon prepared donor tissue.

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“…For example, after PK, immediate CEC loss of 26% is observed, while DSEK kills 9% - 56% of CECs depending on insertion technique (Ide et al, 2007; Mehta et al, 2008; Price and Price, 2008; Terry et al, 2009a; Terry et al, 2013). Injection of DMEK grafts is associated with 27 – 32% CEC loss (Schallhorn et al, 2015). In cataract surgery, indentation of the endothelial surface due to collisions of rogue lens fragments (Amir-Asgari et al, 2016) is associated with CEC.…”

Section: Introductionmentioning

confidence: 99%

Vulnerability of corneal endothelial cells to mechanical trauma from indentation forces assessed using contact mechanics and fluorescence microscopy

Ramirez-Garcia

Khalifa

Buckley

2018

Experimental Eye Research

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Corneal endothelial cell (CEC) loss occurs from tissue manipulation during anterior segment surgery and corneal transplantation as well as from contact with synthetic materials like intraocular lenses and tube shunts. While several studies have quantified CEC loss for specific surgical steps, the vulnerability of CECs to isolated, controllable and measurable mechanical forces has not been assessed previously. The purpose of this study was to develop an experimental testing platform where the susceptibility of CECs to controlled mechanical trauma could be measured. The corneal endothelial surfaces of freshly dissected porcine corneas were subjected to a range of indentation forces via a spherical stainless steel bead. A cell viability assay in combination with high-resolution fluorescence microscopy was used to visualize and quantify injured/dead CEC densities before and after mechanical loading. In specimens subjected to an indentation force of 9 mN, the mean ± SD peak contact pressure P was 18.64 ± 3.59 kPa (139.81 ± 26.93 mmHg) in the center of indentation and decreased radially outward. Injured/dead CEC densities were significantly greater (p ≤ 0.001) after mechanical indentation of 9 mN (167 ± 97 cells/mm) compared to before indentation (39 ± 52 cells/mm) and compared to the sham group (34 ± 31 cells/mm). In specimens subjected to "contact only" - defined as an applied indentation force of 0.65 mN - the peak contact pressure P was 7.31 ± 1.5 kPa (54.83 ± 11.25 mmHg). In regions where the contact pressures was below 78% of P (<5.7 kPa or 42.75 mmHg), injured/dead CEC densities were within the range of CEC loss observed in the sham group, suggesting negligible cell death. These findings indicate that CECs are highly susceptible to mechanical trauma via indentation, supporting the established "no-touch" policy for ophthalmological procedures. While CECs can potentially remain viable below contact pressures of 5.7 kPa (42.75 mmHg), this low threshold suggests that prevention of indentation-associated CEC loss may be challenging.

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Quantification and Patterns of Endothelial Cell Loss Due to Eye Bank Preparation and Injector Method in Descemet Membrane Endothelial Keratoplasty Tissues

Cited by 31 publications

References 20 publications

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

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

Eye bank prepared versus surgeon cut endothelial graft tissue for Descemet membrane endothelial keratoplasty

Vulnerability of corneal endothelial cells to mechanical trauma from indentation forces assessed using contact mechanics and fluorescence microscopy

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