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Airaldi M, Zheng Y, Aiello F, Bachmann B, Baydoun L, Ní Dhubhghaill S, Dickman MM, Kaye SB, Fontana L, Gadhvi KA, Moramarco A, Rodriguez Calvo de Mora M, Rocha de Lossada C, Scorcia V, Viola P, Calza S, Levis HJ, Parekh M, Ruzza A, Ferrari S, Ponzin D, Semeraro F, Romano V. Preoperative surgeon evaluation of corneal endothelial status: the Viability Control of Human Endothelial Cells before Keratoplasty (V-CHECK) study protocol. BMJ Open Ophthalmol 2023; 8:e001361. [PMID: 37730252 PMCID: PMC10510883 DOI: 10.1136/bmjophth-2023-001361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION The success of keratoplasty strongly depends on the health status of the transplanted endothelial cells. Donor corneal tissues are routinely screened for endothelial damage before shipment; however, surgical teams have currently no means of assessing the overall viability of corneal endothelium immediately prior to transplantation. The aim of this study is to validate a preoperative method of evaluating the endothelial health of donor corneal tissues, to assess the proportion of tissues deemed suitable for transplantation by the surgeons and to prospectively record the clinical outcomes of a cohort of patients undergoing keratoplasty in relation to preoperatively defined endothelial viability. METHODS AND ANALYSIS In this multicentre cohort study, consecutive patients undergoing keratoplasty (perforating keratoplasty, Descemet stripping automated endothelial keratoplasty (DSAEK), ultra-thin DSAEK (UT-DSAEK) or Descemet membrane endothelial keratoplasty) will be enrolled and followed-up for 1 year. Before transplantation, the endothelial viability of the donor corneal tissue will be evaluated preoperatively through trypan blue staining and custom image analysis to estimate the overall percentage of trypan blue-positive areas (TBPAs), a proxy of endothelial damage. Functional and structural outcomes at the end of the follow-up will be correlated with preoperatively assessed TBPA values. ETHICS AND DISSEMINATION The protocol will be reviewed by the ethical committees of participating centres, with the sponsor centre issuing the final definitive approval. The results will be disseminated on ClinicalTrials.gov, at national and international conferences, by partner patient groups and in open access, peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05847387.
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Affiliation(s)
- Matteo Airaldi
- Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Yalin Zheng
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Francesco Aiello
- Department of Experimental Medicine, Università degli Studi di Roma Tor Vergata, Roma, Italy
| | - Björn Bachmann
- Department of Ophthalmology, Uniklinik Köln, Koln, Germany
| | - Lamis Baydoun
- Department of Ophthalmology, Universitätsklinikum Münster, Munster, Germany
- ELZA Institute, Dietikon, Zurich, Switzerland
| | - Sorcha Ní Dhubhghaill
- Department of Translational Neurosciences, University Hospital Antwerp, Wilrijk, Belgium
- Department of Ophthalmology, University Hospital of Brussel, Jette, Belgium
| | - Mor M Dickman
- Eye Clinic, Maastricht UMC+, Maastricht, The Netherlands
- MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands
| | - Stephen B Kaye
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Luigi Fontana
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Kunal A Gadhvi
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Marina Rodriguez Calvo de Mora
- Hospital Regional Universitario de Málaga, Málaga, Spain
- Qvision, VITHAS Almería, Almería, Spain
- Department of Ophthalmology, VITHAS Málaga, Málaga, Spain
| | - Carlos Rocha de Lossada
- Hospital Regional Universitario de Málaga, Málaga, Spain
- Qvision, VITHAS Almería, Almería, Spain
- Department of Ophthalmology, VITHAS Málaga, Málaga, Spain
- Surgery Department, Ophthalmology Area, University of Seville, Sevilla, Spain
| | - Vincenzo Scorcia
- Department of Medical and Surgical Sciences, Università degli Studi "Magna Græcia" di Catanzaro, Catanzaro, Italy
| | - Pietro Viola
- Ophthalmology Unit, Ospedale San Bortolo di Vicenza, Vicenza, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Hannah J Levis
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Mohit Parekh
- Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Diego Ponzin
- Fondazione Banca degli Occhi del Veneto, Venezia, Italy
| | - Francesco Semeraro
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Università degli Studi di Brescia, Brescia, Italy
| | - Vito Romano
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Università degli Studi di Brescia, Brescia, Italy
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Borroni D, Rocha-de-Lossada C, Bonci P, Rechichi M, Rodríguez-Calvo-de-Mora M, Rachwani-Anil R, Sánchez González JM, Urbinati F, Lorente MG, Vigo L, Carones F. Glasses-Assisted 3D Display System-Guided Descemet Membrane Endothelial Keratoplasty Tissue Preparation. Cornea 2022; 41:1444-1446. [PMID: 35184124 DOI: 10.1097/ico.0000000000003005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility of Descemet membrane endothelial keratoplasty (DMEK) tissue preparation using a glasses-assisted 3-dimensional (3D) display system and to compare it with a conventional surgical microscope. METHODS Healthy pairs of human corneas suitable for penetrating keratoplasty surgery were selected for this study. The tissues were randomly divided into 2 groups. Each pair of corneas had 1 cornea (group 1) prepared with NGENUITY (Alcon) with a 5-second staining time with vision blue, and the fellow cornea (group 2) was prepared using a OPMI Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) with a 30-second staining time. DMEK graft preparation time, speed of stripping, graft width, and endothelial cell loss were evaluated. RESULTS Twenty-eight pairs of corneas were included in this study. The graft preparation time was significantly higher in the 3D group than in the conventional group (498 ± 147 vs. 418 ± 85 seconds, P value = 0.031). The mean speed of stripping was 0.59 ± 0.081 mm/s in group 1 and 0.089 ± 0.005 mm/s in group 2 ( P value = 0.024). The mean endothelial cell density in group 1 and group 2 before tissue preparation was 2162 ± 115.21 and 2153 ± 122.45, respectively ( P value > 0.1). After tissue preparation, the endothelial cell density reduced to 1911 ± 150.72 in group 1 and 1998 ± 90.72 in group 2 ( P value = P value > 0.05). The graft width was 5.05 ± 0.71 mm in group 1 and 4.92 ± 0.23 mm in group 2 ( P value > 0.05). CONCLUSIONS DMEK tissue preparation with 3D display system NGENUITY is feasible with a slightly increased preparation time. The improved visualization allows a reduced staining time that could be beneficial for eye banks because it may reduce the toxic effect of staining colorants.
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Affiliation(s)
- Davide Borroni
- Department of Doctoral Studies, Riga Stradins University, Riga, Latvia
- Advalia Vision, Cornea Research Unit, Milan, Italy
| | - Carlos Rocha-de-Lossada
- Department of Ophthalmology, Qvision (Vithas Almeria)
- University Hospital Virgen de Las Nieves, Granada, Spain
- Department of Ophthalmology, Ceuta Medical Center, Ceuta, Spain
| | - Paola Bonci
- Ospedale Civile di Ravenna, Banca Delle Cornee Della Regione Emilia-Romagna
| | | | | | | | | | | | | | - Luca Vigo
- Advalia Vision, Cornea Research Unit, Milan, Italy
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Avetisov SE, Osipyan GA, Abukerimova AK, Akovantseva AA, Efremov YM, Frolova AA, Kotova SL, Timashev PS. [Experimental studies of the biomechanical properties of the cornea]. Vestn Oftalmol 2022; 138:124-131. [PMID: 35801891 DOI: 10.17116/oftalma2022138031124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The review presents the results of experimental studies of the biomechanical properties of the cornea. Selective evaluation of the individual corneal structures (for example, limiting membranes) using classical mechanical tests is to a certain extent limited due to the rather small thickness of these structures and the related difficulties in sample fixation. In real practice, the use of a method better adapted for conducting such studies - atomic force microscopy (AFM) - remains promising, since on the one hand it eliminates the need for mechanical capture and retention of the sample, and on the other - provides the capability for studying its segments separately.
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Affiliation(s)
- S E Avetisov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Research Institute of Eye Diseases, Moscow, Russia
| | - G A Osipyan
- Research Institute of Eye Diseases, Moscow, Russia
| | | | - A A Akovantseva
- Institute of Photonic Technologies of the Crystallography and Photonics Research Center, Moscow, Russia
| | - Yu M Efremov
- Institute of Regenerative Medicine of the I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A A Frolova
- Digital Biodesign and Personalized Healthcare Center of the I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S L Kotova
- Institute of Regenerative Medicine of the I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- N.N. Semenov Federal Research Center for Chemical Physics, Moscow, Russia
| | - P S Timashev
- Institute of Regenerative Medicine of the I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Digital Biodesign and Personalized Healthcare Center of the I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- N.N. Semenov Federal Research Center for Chemical Physics, Moscow, Russia
- Lomonosov Moscow State University, Moscow, Russia
- Institute of Photonic Technologies of the Crystallography and Photonics Research Center, Moscow, Russia
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Vasanthananthan K, Kocaba V, Dapena I, Melles GR. Misconceptions in DMEK surgery. Acta Ophthalmol 2021; 100:e1186. [PMID: 34651446 DOI: 10.1111/aos.15037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/22/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Keamela Vasanthananthan
- Netherlands Institute for Innovative Ocular Surgery Rotterdam the Netherlands
- Melles Cornea Clinic Rotterdam Rotterdam the Netherlands
| | - Viridiana Kocaba
- Netherlands Institute for Innovative Ocular Surgery Rotterdam the Netherlands
- Melles Cornea Clinic Rotterdam Rotterdam the Netherlands
- Tissue Engineering and Cell Therapy Group Singapore Eye Research Institute Singapore Singapore
| | - Isabel Dapena
- Netherlands Institute for Innovative Ocular Surgery Rotterdam the Netherlands
- Melles Cornea Clinic Rotterdam Rotterdam the Netherlands
| | - Gerrit R.J. Melles
- Netherlands Institute for Innovative Ocular Surgery Rotterdam the Netherlands
- Melles Cornea Clinic Rotterdam Rotterdam the Netherlands
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Lekhanont K, Pisitpayat P, Cheewaruangroj N, Jongkhajornpong P, Nonpassopon M, Anothaisintawee T. Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand. Clin Ophthalmol 2021; 15:2239-2251. [PMID: 34103888 PMCID: PMC8180280 DOI: 10.2147/opth.s310873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the medium-term clinical outcomes and risk factors for primary graft failure after Descemet membrane endothelial keratoplasty (DMEK) in Thai patients. Patients and Methods This is a single-center retrospective cohort study. Sixty-two eyes of 62 patients who underwent DMEK at Ramathibodi Hospital, Bangkok, Thailand, with a minimum of 24-month follow-up were recruited. Preoperative donor and recipient characteristics, intraoperative data, and postoperative outcomes including best-corrected visual acuity (BCVA), graft clarity, endothelial cell density (ECD), central corneal thickness (CCT), and complications were evaluated at 1, 3, 6, 12, and 24 months after surgery. Results The mean age of the patients was 67.2 ± 9.9 years, and 52% were female. The mean follow-up time was 37.5 ± 11.0 months. The most common indications for DMEK were Fuchs' endothelial corneal dystrophy (FECD) (53.2%) and pseudophakic bullous keratopathy (PBK) (17.7%). Nearly half of patients had triple-DMEK. The median preoperative BCVA was 20/400. Postoperative BCVA of ≥ 20/40 was reached in 37.1% and of ≥ 20/20 in 6.5% after 1 month which increased to 54.8% and 17.7% after 3 months; and to 67.7% and 27.4% after 24 months. Endothelial cell loss (ECL) at 3, 6, 12, and 24 months was 30.5%, 33.8%, 44.4%, and 45.9%, respectively. Graft diameter was the single factor, showing a significant relationship with postoperative ECD. Most frequent postoperative complications included graft detachment (22.6%), increased IOP/glaucoma (17.7%), and primary graft failure (16.1%). In univariate analysis, death-to-operation time and the diagnosis of PBK were significantly associated with the occurrence of primary graft failure. Conclusion DMEK is a safe, effective, and feasible treatment for endothelial failure in Asian eyes. Careful case selection, use of relatively fresh donor tissues, and appropriate surgical techniques can prevent primary graft failure and facilitate optimal outcomes following surgery.
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Affiliation(s)
- Kaevalin Lekhanont
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Punyanuch Pisitpayat
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nontawat Cheewaruangroj
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Passara Jongkhajornpong
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Manachai Nonpassopon
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Ong HS, Ang M, Mehta J. Evolution of therapies for the corneal endothelium: past, present and future approaches. Br J Ophthalmol 2021; 105:454-467. [PMID: 32709756 PMCID: PMC8005807 DOI: 10.1136/bjophthalmol-2020-316149] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/16/2020] [Indexed: 12/13/2022]
Abstract
Corneal endothelial diseases are leading indications for corneal transplantations. With significant advancement in medical science and surgical techniques, corneal transplant surgeries are now increasingly effective at restoring vision in patients with corneal diseases. In the last 15 years, the introduction of endothelial keratoplasty (EK) procedures, where diseased corneal endothelium (CE) are selectively replaced, has significantly transformed the field of corneal transplantation. Compared to traditional penetrating keratoplasty, EK procedures, namely Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), offer faster visual recovery, lower immunological rejection rates, and improved graft survival. Although these modern techniques can achieve high success, there are fundamental impediments to conventional transplantations. A lack of suitable donor corneas worldwide restricts the number of transplants that can be performed. Other barriers include the need for specialized expertise, high cost, and risks of graft rejection or failure. Research is underway to develop alternative treatments for corneal endothelial diseases, which are less dependent on the availability of allogeneic tissues - regenerative medicine and cell-based therapies. In this review, an overview of past and present transplantation procedures used to treat corneal endothelial diseases are described. Potential novel therapies that may be translated into clinical practice will also be presented.
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Affiliation(s)
- Hon Shing Ong
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore
| | - Marcus Ang
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore
| | - Jodhbir Mehta
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore
- School of Material Science & Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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Abdelmassih Y, Beaujeux P, Dureau P, Edelson C, Caputo G. Incidence and Risk Factors of Glaucoma Following Pediatric Cataract Surgery With Primary Implantation. Am J Ophthalmol 2021; 224:1-6. [PMID: 32950509 DOI: 10.1016/j.ajo.2020.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine the incidence and risk factors for glaucoma after pediatric cataract surgery with intraocular lens (IOL) implantation. DESIGN Retrospective, consecutive case series. METHODS In this single-center study, we reviewed 136 children (199 eyes) who underwent pediatric cataract surgery before 1 year of age with a minimum of 1 year of follow-up. The intervention used was pediatric cataract surgery with IOL implantation, and the primary outcome measure was the presence or absence of secondary glaucoma. RESULTS The mean age at surgery was 148 ± 93 days (range 30-359 days) with a mean follow-up of 6.3 ± 3.6 years (range 1.1-12.8 years). Glaucoma developed in 31 eyes (16%) with 5- and 10-year incidence rates of 12% and 28%, respectively. The incidence of glaucoma seemed to be bimodal, with a first peak occurring after a mean delay of 2.5 months (range 1.6-4.1 months) and a second peak occurring after a mean delay of 5.7 years (range 2.6-11.7 years). Younger age at surgery, shorter axial length, longer follow-up, use of trypan blue, reintervention, and bilateral surgery were associatied with a higher incidence of glaucoma. Multivariate analysis including the aforementioned variables indentified longer follow-up (odds ratio [OR] = 1.3 [95% confidence interval {CI} 1.1-1.6], P = .001), reintervention (OR = 4.1 [95% CI 1.2-13.4], P = 0.02), and the use of trypan blue (OR = 4.1 [95% CI 1.3-13.1], P = .02) as predictors for the development of glaucoma. CONCLUSION Glaucoma is a common complication after pediatric cataract surgery. It seemed to have a bimodal incidence. Risk factors for glaucoma development were reintervention, the use of trypan blue, and a long follow-up.
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Shen Y, Zhang L, Zhou H, Wu M. Comparative effects of commonly used intraocular dyes on the viability of human retina Müller cells. Biomed Pharmacother 2020; 132:110790. [PMID: 33035834 DOI: 10.1016/j.biopha.2020.110790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022] Open
Abstract
This study investigated the in vitro effect of various vital dyes in common clinical use on human Müller cell viability, and it compared the toxicity of these dyes using a cell culture model. Müller cells were exposed to a series of concentrations (1 %, 0.5 %, 0.25 %, and 0.125 % or 12.9 mM, 6.45 mM, 3.22 mM and 1.61 mM) of Indocyanine green (ICG) for 2, 24, 48, and 72 h. Similarly, groups of Müller cells were stained with "Heavy" brilliant blue G (HBBG), Trypan blue (TB) (0.15 %, or 1.56 mM), Membrane-blue-dual (MBD), and ICG (0.25 %, or 3.22 mM) or BBG (0.025 %, or 0.3 mM) with glucose (GS) (50 %, 66 % and 75 % or 2.78 M, 3.67 M and 4.17 M) for 30, 60, and 120 s. Cell viability was measured with the Cell Counting Kit-8 (CCK-8) and Lactate Dehydrogenase (LDH) release assays. We found that high stain concentration and long exposure time resulted in increased toxicity to Müller cells. Nevertheless, ICG seemed to be safe at the clinically relevant concentration of 0.25 % (3.22 mM) in the short time of exposure. TB was safer than both HBBG and MBD, especially HBBG. Hypertonic GS as a dilution was not safe for Müller cells, and the negative effect was more obvious in 0.025 % (0.3 mM) BBG than that in 0.25 % (3.22 mM) ICG. This is the first report to observe the cytotoxicity of commonly used stains in clinical on human Müller cells in vitro, and to provide some basis for further studies, including in vivo investigation.
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Affiliation(s)
- Yu Shen
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province, People's Republic of China.
| | - Luyi Zhang
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province, People's Republic of China
| | - Huihui Zhou
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province, People's Republic of China
| | - Miaoqin Wu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province, People's Republic of China.
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Solar SJ, Deljookorani S, Wiener BG, Rosen A, Chaurasia A, Shahmirzadi M, Meshkin RS, Dzhaber D, Chiang E, Barnes K, Chen CY, Koo EH, Eghrari AO. Preloading Trifolded Grafts for Descemet Membrane Endothelial Keratoplasty Affects Scroll Formation. Cornea 2020; 39:1062-1065. [PMID: 32118669 PMCID: PMC9922540 DOI: 10.1097/ico.0000000000002298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE The trifolded, endothelium-in approach to Descemet membrane endothelial keratoplasty (DMEK) facilitates tissue insertion into the anterior chamber. We hypothesized that preloading the trifolded donor grafts in a cartridge for 48 hours before insertion would induce biomechanical changes that decrease their scrolling tendency compared with those loaded immediately before insertion. METHODS Ten Descemet membrane donor grafts, peeled and cut to 8.0 mm, were prepared by a single eye bank technician. Each graft was trifolded and pulled into a DMEK cartridge and stored for 48 hours. They were then pulled with microforceps into a petri dish filled with balanced salt solution. A video was recorded of the graft becoming a scroll over a 2-minute period. Each graft, serving as its own control, was then trifolded, pulled into the cartridge, and the process repeated. Images from 1, 5, 10, 60, and 120 seconds were extracted from video recording of the procedures. Scroll width was analyzed by graders masked to group assignment. A paired t test was used to determine differences in scroll width at each time point between the 48-hour and instant trifolding conditions. RESULTS All grafts scrolled after removal from the cartridge into balanced salt solution. We measured a significant difference at all time points 1 through 120 seconds (4.02 preloaded vs. 2.91-mm instant trifold, P = 0.035). CONCLUSIONS Preloading DMEK grafts in a trifolded configuration for 48 hours reduces the scrolling tendency of Descemet membrane for at least 2 minutes.
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Affiliation(s)
- Steven J. Solar
- Department of Biomechanical Engineering, Johns Hopkins Whiting School of Engineering
| | | | - Batya G. Wiener
- Department of Biomechanical Engineering, Johns Hopkins Whiting School of Engineering
| | - Allison Rosen
- Department of Biomechanical Engineering, Johns Hopkins Whiting School of Engineering
| | - Akash Chaurasia
- Department of Biomechanical Engineering, Johns Hopkins Whiting School of Engineering
| | - Monady Shahmirzadi
- Department of Ophthalmology, Johns Hopkins University School of Medicine
| | | | - Daliya Dzhaber
- Department of Ophthalmology, Johns Hopkins University School of Medicine
| | - Eric Chiang
- Department of Biomechanical Engineering, Johns Hopkins Whiting School of Engineering
| | - Kali Barnes
- Department of Biomechanical Engineering, Johns Hopkins Whiting School of Engineering
| | | | - Ellen H. Koo
- Bascom Palmer Eye Institute, West Palm Beach, Florida, USA
| | - Allen O. Eghrari
- Department of Ophthalmology, Johns Hopkins University School of Medicine
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Chamani T, Javadi MA, Kanavi MR. Trephine- and dye-free technique for eye bank preparation of pre-stripped Descemet membrane endothelial keratoplasty tissue. Cell Tissue Bank 2019; 20:321-326. [DOI: 10.1007/s10561-019-09771-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 05/10/2019] [Indexed: 11/28/2022]
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Evaluation of Patent Blue as the Vital Dye in an Animal Model of Descemet Membrane Endothelial Keratoplasty. Cornea 2019; 38:360-363. [PMID: 30601173 DOI: 10.1097/ico.0000000000001833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the safety and feasibility of patent blue (PB) as the vital dye in Descemet membrane endothelial keratoplasty (DMEK). METHODS Bovine corneal endothelial cells were incubated with different concentrations (0.02%-2.5%) of PB. The cell viability, which was assessed by Cell Counting Kit-8 assay, was compared with that of untreated control and 0.06% to 0.4% trypan blue. The dyes were also used for graft preparation and implantation in the porcine eye model to evaluate stain quality, dye retention, and the feasibility of using PB in DMEK surgery. RESULTS No obvious increase in cytotoxicity was detected for 0.06% to 0.4% trypan blue and PB at concentrations up to 1.0%, but the cell viability after incubating with 1.5% to 2.5% PB was significantly reduced. PB at 0.5% to 1.0% generated good staining quality that can be used to facilitate graft implantation. Although the staining quality of 0.5% to 1.0% PB faded to an intermediate level after a 30-minute wash in phosphate-buffered saline, dye retention persisted for up to 24 hours. CONCLUSIONS PB at 0.5% to 1.0% is biocompatible and can stain the graft sufficiently, making it an alternative for DMEK surgery.
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“Ghost DMEK” Technique: Circular Peripheral Staining of Descemet's Membrane Endothelial Keratoplasty Grafts. Cornea 2018; 38:252-255. [DOI: 10.1097/ico.0000000000001816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ma J, Wang Y, Wei P, Jhanji V. Biomechanics and structure of the cornea: implications and association with corneal disorders. Surv Ophthalmol 2018; 63:851-861. [PMID: 29857022 DOI: 10.1016/j.survophthal.2018.05.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 12/14/2022]
Abstract
Recent studies have shown that alterations in corneal biomechanical properties are associated with corneal pathologies, particularly corneal ectasia. Moreover, these alterations may have implications with regard to the outcomes of therapeutic modalities and corneal refractive surgeries. We address corneal anatomy and its relevance to corneal biomechanical characteristics, as well as ocular and systemic conditions associated with changes in corneal biomechanics.
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Affiliation(s)
- Jiaonan Ma
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China; Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Naikai University, Tianjin Medical University, Tianjin, China.
| | - Pinghui Wei
- Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Naikai University, Tianjin Medical University, Tianjin, China
| | - Vishal Jhanji
- UPMC Eye Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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