Parekh M, Ruzza A, Ferrari S, Ahmad S, Kaye S, Ponzin D, Romano V.
Endothelium-in versus endothelium-out for Descemet membrane endothelial keratoplasty graft preparation and implantation.
Acta Ophthalmol 2017;
95:194-198. [PMID:
27422483 DOI:
10.1111/aos.13162]
[Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/13/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE
To evaluate the difference between endothelium-in and endothelium-out for Descemet membrane endothelial keratoplasty (DMEK) preparation and implantation using injection method.
METHODS
The study was a randomized, comparative, institutional, laboratory investigation. Eighteen human donor corneas were included. A total of 9.5 mm DMEK grafts were stripped and restored on the corneal base with a hinge and preserved in the deswelling medium. The grafts were detached from the hinge and either manually tri-folded with the endothelium on the inside, or allowed to spontaneously roll in phosphate-buffered saline (PBS) with endothelium outwards. The corneas were mounted on an artificial anterior chamber (AAC) and four incisions made using a 15° eye knife for the side ports and slit knife to create a 3.0 mm incision for delivery of the graft into the AAC. The grafts with endothelium-in (endo-in) were pulled into a cartridge, whereas those with endothelium-out (endo-out) were aspirated using a modified Jones tube. Both were delivered using an injection method. Central and peripheral endothelial cell density (pre- and post-delivery and after removal), time of preparation and unfolding were measured.
RESULTS
Endothelial cell loss postimplantation was 10.53% (±2.82) with endo-in (n = 9) compared to 7.56% (±14.74) with endo-out (n = 9) (p > 0.05). Preparation and unfolding time was 4.43 min (±3.43) and 0.96 min (±1.10) for endo-in compared to 1.68 min (±0.57) and 4.92 min (±4.21) for endo-out. A statistical significance between endo-in and endo-out for loading (p = 0.04) and unfolding (p = 0.023) time was observed.
CONCLUSIONS
Descemet membrane endothelial keratoplasty tissues can be tri-folded (endo-in) with no significantly less cell loss as compared to endo-out. Spontaneous unfolding of endo-in may reduce overall time and surgical manipulation.
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