Stamping an S on DMEK Donor Tissue to Prevent Upside-Down Grafts

Veldman, Peter B.; Dye, Philip K.; Holiman, Jeffrey D.; Mayko, Zachary M.; Sáles, Christopher S.; Straiko, Michael D.; Stoeger, Christopher G.; Terry, Mark A.

doi:10.1097/ico.0000000000000522

Cited by 80 publications

(23 citation statements)

References 16 publications

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“… 8 Veldman et al stamped an S on DMEK donor tissue to orientate the graft. 9 Bachmann et al created asymmetric marks on the edge of the graft using a 1-millimetre-diameter dermatological biopsy punch. 10 Bhogal et al had recently introduced single triangular mark using a 30° incision knife.…”

Section: Introductionmentioning

confidence: 99%

Use of four asymmetric marks to orient the donor graft during Descemet's membrane endothelial keratoplasty

et al. 2017

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IntroductionMaintaining the correct orientation of the donor graft is important during Descemet's membrane endothelial keratoplasty (DMEK). We describe a new method of marking the donor graft prior to DMEK.MethodsTwelve eyes of 10 patients with bullous keratopathy who underwent DMEK were retrospectively analysed. Donor discs were created by stripping the endothelium–Descemet's membrane layer from corneoscleral buttons. Four semicircular marks, two 1.0 mm and two 1.5 mm in diameter, were created at the edge of the donor disc. The small and large marks were paired. Each donor graft was inserted into the anterior chamber, unfolded and attached to the posterior corneal stroma with an air bubble.ResultsThe inserted grafts were all appropriately orientated when attached to the back surfaces of the corneas. The two pairs of asymmetric marks afforded valuable guidance. Even when the graft was partially folded or decentred, and one pair of marks was obscured, the other pair was always visible to indicate graft orientation. Best spectacle-corrected visual acuity improved significantly in all patients (p<0.001). Compared with the preoperative endothelial cell density of the donor graft, that of the corneal endothelium had decreased 44.0%±10.0% by 6 months after surgery.ConclusionsTwo pairs of asymmetrical semicircular marks placed on the edge of the donor graft allowed appropriate graft orientation during DMEK.

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Section: Introductionmentioning

confidence: 99%

Use of four asymmetric marks to orient the donor graft during Descemet's membrane endothelial keratoplasty

et al. 2017

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“…Vital dye staining facilitates the identification of graft orientation. Various methods have been used to determine graft orientation, including graft staining per se [12], graft marking [13], graft stamping [14], and intraoperative optical coherence tomography (OCT) [15, 16]. We have trialled all of these methods.…”

Section: Introductionmentioning

confidence: 99%

Use of Brilliant Blue G in Descemet’s Membrane Endothelial Keratoplasty

Hayashi

Yuda

Oyakawa

et al. 2017

BioMed Research International

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Vital staining of the endothelial graft is essential during Descemet's membrane endothelial keratoplasty (DMEK) to ensure surgical success. DMEK surgeons worldwide commonly use trypan blue (TB) to this end. However, TB may exert toxic effects on both the cornea and retina. Recently, Brilliant Blue G (BBG) has become recognized as an alternative stain for use during vitreoretinal surgery; BBG is associated with lower levels of toxicity. We retrospectively analyzed the utility of BBG staining during DMEK. We used 0.1% (w/v) BBG to stain the DMEK grafts of 12 patients. We evaluated the best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) before and 3 and 6 months after surgery. BBG was effective in terms of graft visualization during DMEK. The BSCVA (log MAR) improved from 0.99 ± 0.57 to 0.01 ± 0.07 (p < 0.05). The CCT decreased from 720.3 ± 58.1 μm preoperatively to 511.5 ± 50.6 μm at 6 months postoperatively (p = 0.0001). The ECD decreased from 2,754 ± 296 cells/mm2 to 1,708 ± 426 cells/mm2 at 6 months postoperatively (p < 0.001). The ECD loss was 37.9 ± 16.3%. The outcomes using BBG were comparable to those of earlier reports that employed TB; thus, BBG may be a viable alternative to TB.

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“…23 In method 2, the grafts are peeled 90% off and then laid back on the stroma prior to transplantation. 24 This is the predominant method followed in US eye banks working with cold storage media and has also been adopted by the Venice eye bank in an organ culture system. In method 3, also described by the Venice eye bank, the DM is separated from the stroma by creating a fluid bubble and then shipped with or without removing the stroma.…”

Section: Introductionmentioning

confidence: 99%

Organ culture storage of pre-prepared corneal donor material for Descemet's membrane endothelial keratoplasty

et al. 2016

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PurposeTo evaluate the effect of media composition and storage method on pre-prepared Descemet's membrane endothelial keratoplasty (DMEK) grafts.Methods50 corneas were used. Endothelial wound healing and proliferation in different media were assessed using a standard injury model. DMEK grafts were stored using three methods: peeling with free scroll storage; partial peeling with storage on the stroma and fluid bubble separation with storage on the stroma. Endothelial cell (EC) phenotype and the extent of endothelial overgrowth were examined. Global cell viability was assessed for storage methods that maintained a normal cell phenotype.Results1 mm wounds healed within 4 days. Enhanced media did not increase EC proliferation but may have increased EC migration into the wounded area. Grafts that had been trephined showed evidence of EC overgrowth, whereas preservation of a physical barrier in the bubble group prevented this. In grafts stored in enhanced media or reapposed to the stroma after trephination, endothelial migration occurred sooner and cells underwent endothelial-mesenchymal transformation. Ongoing cell loss, with new patterns of cell death, was observed after returning grafts to storage. Grafts stored as free scrolls retained more viable ECs than grafts prepared with the fluid bubble method (74.2± 3% vs 60.3±6%, p=0.04 (n=8).ConclusionFree scroll storage is superior to liquid bubble and partial peeling techniques. Free scrolls only showed overgrowth of ECs after 4 days in organ culture, indicating a viable time window for the clinical use of pre-prepared DMEK donor material using this method. Methods for tissue preparation and storage media developed for whole corneas should not be used in pre-prepared DMEK grafts without prior evaluation.

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Stamping an S on DMEK Donor Tissue to Prevent Upside-Down Grafts

Abstract: Our novel S-stamp donor tissue preparation technique is intuitive to learn and holds the promise of preventing iatrogenic primary graft failure due to upside-down grafts without causing unacceptable increases in ECL.

Cited by 80 publications

References 16 publications

Use of four asymmetric marks to orient the donor graft during Descemet's membrane endothelial keratoplasty

Use of four asymmetric marks to orient the donor graft during Descemet's membrane endothelial keratoplasty

Use of Brilliant Blue G in Descemet’s Membrane Endothelial Keratoplasty

Organ culture storage of pre-prepared corneal donor material for Descemet's membrane endothelial keratoplasty

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