Standardizing Descemet Membrane Endothelial Keratoplasty Graft Preparation Method in the Eye Bank—Experience of 527 Descemet Membrane Endothelial Keratoplasty Tissues

Parekh, Mohit; Baruzzo, Mattia; Favaro, Elisa; Borroni, Davide; Ferrari, Stefano; Ponzin, Diego; Ruzza, Alessandro

doi:10.1097/ico.0000000000001349

Cited by 53 publications

(41 citation statements)

References 26 publications

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“…Donor preparation by an eye bank can be a valuable option for surgeons because eye bank operators have experience preparing a significant volume of corneas on a daily basis, which reduces the graft preparation time, tissue wastage, and overall costs. 171 , 172 Prestripped DMEK grafts can also be preloaded in an eye bank without additional endothelial cell loss, making the procedure more efficient. 173 , 174 To prevent endothelial cell loss because of the graft scraping against the injector, DMEK tissue is manually tri-folded with the endothelial side inward before being inserted into the cartridge.…”

Section: Corneal Transplantationmentioning

confidence: 99%

Corneal endothelial cell dysfunction: etiologies and management

Feizi

2018

Ophthalmol Eye Dis

100

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A transparent cornea is essential for the formation of a clear image on the retina. The human cornea is arranged into well-organized layers, and each layer plays a significant role in maintaining the transparency and viability of the tissue. The endothelium has both barrier and pump functions, which are important for the maintenance of corneal clarity. Many etiologies, including Fuchs’ endothelial corneal dystrophy, surgical trauma, and congenital hereditary endothelial dystrophy, lead to endothelial cell dysfunction. The main treatment for corneal decompensation is replacement of the abnormal corneal layers with normal donor tissue. Nowadays, the trend is to perform selective endothelial keratoplasty, including Descemet stripping automated endothelial keratoplasty and Descemet’s membrane endothelial keratoplasty, to manage corneal endothelial dysfunction. This selective approach has several advantages over penetrating keratoplasty, including rapid recovery of visual acuity, less likelihood of graft rejection, and better patient satisfaction. However, the global limitation in the supply of donor corneas is becoming an increasing challenge, necessitating alternatives to reduce this demand. Consequently, in vitro expansion of human corneal endothelial cells is evolving as a sustainable choice. This method is intended to prepare corneal endothelial cells in vitro that can be transferred to the eye. Herein, we describe the etiologies and manifestations of human corneal endothelial cell dysfunction. We also summarize the available options for as well as recent developments in the management of corneal endothelial dysfunction.

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Section: Corneal Transplantationmentioning

confidence: 99%

Corneal endothelial cell dysfunction: etiologies and management

Feizi

2018

Ophthalmol Eye Dis

100

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“…As stripping techniques have provided better graft quality compared with bubble techniques in this study and also from our previous experience (Parekh et al 2017), it is recommended to use a stripping method. M3 has shown to have the best graft quality, however, as the overall expenses and time of preparation for this method is significantly high for any low volume eye bank, it may have strict limitations.…”

Section: Discussionmentioning

confidence: 65%

“…A para‐central DMEK graft can be achieved this way (Parekh et al. ). However, these kind of tissues can only be stripped and cannot be bubbled as the bubble will pop out and the tissue will be torn or the liquid will leak from the incision site never allowing a bubble generation.…”

Section: Discussionmentioning

confidence: 99%

“…However, for cases such as previous cataract incision and horse shoe shaped tears, it is recommended that the PoI should be from the opposite ends of the incision or rejecting the area of incision and initiating the stripping just after the incision. A paracentral DMEK graft can be achieved this way (Parekh et al 2017). However, these kind of tissues can only be stripped and cannot be bubbled as the bubble will pop out and the tissue will be torn or the liquid will leak from the incision site never allowing a bubble generation.…”

Section: Discussionmentioning

confidence: 99%

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A comparative study on different Descemet membrane endothelial keratoplasty graft preparation techniques

Parekh

Borroni

Ruzza

et al. 2018

Acta Ophthalmologica

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“…The tissues (n=6, from each condition), after preservation, were washed with PBS and the Descemet membrane-endothelial complex was peeled using a standard stripping technique used for Descemet membrane endothelial keratoplasty (DMEK) 12 . The stripped DMEK tissue was fixed in 4% paraformaldehyde at room temperature (RT) for 20 minutes'.…”

Section: Alizarin Red Stainingmentioning

confidence: 99%

Human Corneal Endothelial Cell Assessment From Tissues Preserved in Serum-Based and Synthetic Storage Media

Parekh

Ruzza

Ponzin

et al. 2019

Cornea

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Aim: To assess the difference between endothelial cells from the tissues preserved in media supplemented with fetal bovine serum (FBS) and recombinant human serum albumin (rHSA). Methods: In a donor matched study, 48 tissues were preserved for 28 days at 31 o C in Cornea Max ® and Cornea Syn ® supplemented with FBS and rHSA respectively. Endothelial cells were visualized by two masked observers before and after preservation. Endothelial cell density (ECD) and number of iatrogenic folds were counted manually. Alizarin red staining and tight junction protein (ZO-1) were used to assess cell morphology (hexagonality and polymorphism). Intra and inter-observer cell counts were recorded and analyzed. Wilcoxon and one-way ANOVA tests were used where p<0.05 was deemed statistically significantly different. Results: Significant amount of iatrogenic folds were observed in the tissues supplemented with FBS compared with rHSA post-preservation (p=0.0007). Approximately 69% and 71% hexagonal cells (p=0.0303) and; 29% and 26% polymorphic cells (p=0.0234) were observed in FBS and rHSA groups, respectively. Post-preservation, operator 1 counted 1766 cells/mm 2 in FBS and 1864 cells/mm 2 in rHSA. Operator 2 counted 1702 cells/mm 2 in FBS and 1858 cells/mm 2 in rHSA. ECD counts from FBS (inter-operator) were statistically significant (p=0.0429). However, significance was not observed in the ECD counts (inter-operator) from the rHSA preserved tissues (p=0.8738). Conclusions: rHSA supplemented media allows better visualization of the corneal endothelial cells. This reduces the rate of discard observed due to counting errors. Use of rHSA improves the current standard of care and reduces the use of animal derived products.

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Standardizing Descemet Membrane Endothelial Keratoplasty Graft Preparation Method in the Eye Bank—Experience of 527 Descemet Membrane Endothelial Keratoplasty Tissues

Cited by 53 publications

References 26 publications

Corneal endothelial cell dysfunction: etiologies and management

Corneal endothelial cell dysfunction: etiologies and management

A comparative study on different Descemet membrane endothelial keratoplasty graft preparation techniques

Human Corneal Endothelial Cell Assessment From Tissues Preserved in Serum-Based and Synthetic Storage Media

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