Safety of Long-Term Storage and Shipping of Prestripped, Prestained, and Preloaded Descemet Membrane Endothelial Keratoplasty Tissue

Abstract

Purpose: The purpose of this study was to determine the safety of long-term storage and shipping of prestripped, prestained, and preloaded Descemet membrane endothelial keratoplasty (p3DMEK) grafts. Methods: A total of 33 cadaveric corneas were prestripped, prestained, and preloaded using modified Jones tube injectors as p3DMEK. The corneas were masked to groups that were prepared <9 hours (control), 48 hours, and 72 hours before unloading and analysis. The 48- and 72-hour tissues were shipped by airfreight on each day before arrival to simulate domestic and international shipping. The corneas were then stained using Calcein AM vital dye (Molecular Probes, Eugene, OR) and imaged using an inverted confocal microscope. Primary outcome measures were endothelial cell loss (ECL, %) and sustainability of staining. MetaMorph software (Molecular Devices, Downingtown, PA) was used to quantify ECL, and staining was evaluated subjectively using all-or-none rating. Results: There was no difference in the mean ECL for the control, 48-hour, and 72-hour groups, which were 25.1% ± 8.8%, 26.4% ± 17.5%, and 19.2% ± 11.5%, respectively (P = 0.45; Kruskal–Wallis test). In all tissues of each group, no loss of staining was identified at each time point of analysis. Conclusions: ECL in p3DMEK tissue prepared 48 and 72 hours in advance and shipped using standard methods is similar to that in p3DMEK tissue prepared on the same day. These findings support the safety of domestic and international shipping of p3DMEK grafts.

Surgeon Preferences for Endothelial Keratoplasty in Canada

“…Eye bank-prepared tissue has been shown to have equivalent quality to surgeon prepared grafts, with acceptable levels of cell death even when shipped domestically or internationally. [11][12][13] Eye bank-prepared tissue carries the advantage of reducing the burden on the surgeon's time, eliminating the risk for same-day graft loss during preparation, and reducing the learning curve for surgeons new to DMEK surgery. Eye banks employ skilled technicians for the preparation of DMEK grafts, yet they also have a learning curve to overcome, and in some centers, unacceptable failure rates have been reported.…”

Ink Retention and Endothelial Cell Viability After the Application of an Orientation Stamp Over an Air Bubble During Descemet Membrane Endothelial Keratoplasty Graft Preparation

“…10,17,18,24 The ECL for grafts that underwent shipping was not statistically different from grafts that had not been shipped and was also within the range previously reported in similar shipping studies. 17,25 Therefore, trained eye bank technicians can adopt this technique without concern for introducing additional cell loss during graft preparation.…”

Advances in eye banking and corneal tissue processing

“…More recently, DMEK tissue can be obtained prestripped, prestamped, prestained with trypan blue, and preloaded into an injector from eye bank [57][58][59][60]. Studies have found that DMEK tissue that is prestained and preloaded does not sustain significant additional endothelial cell loss [58,60], can be safely shipped and stored for several days prior to surgery [57,58,60], and maintains sufficient staining for transplantation surgery [58,60]. In a cost-effectiveness study by Bo ¨hm et al, preloaded DMEK was found to be more cost-effective and cost saving compared to nonpreloaded DMEK [61 & ].…”