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Ultra-thin DSAEK using an innovative artificial anterior chamber pressuriser: a proof-of-concept study

  • Basic Science
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Abstract

Purpose

To report the impact of establishing and maintaining a high intracameral pressure (ICP) of 200 mmHg on UT-DSAEK graft preparation using an artificial anterior chamber pressuriser (ACP) control unit (Moria SA, Antony, France).

Method

Retrospective laboratory and clinical study. Four paired donor corneas were mounted on an artificial anterior chamber and subjected to 70 mmHg (“low”) and 200 mmHg (“high”) ICP using an ACP system. The central corneal thinning rate was measured after 5 min using AS-OCT and the endothelial cell viability was analysed using trypan blue and live/dead staining following 70 mmHg and 200 mmHg ICP. Visual outcomes and complications in a clinical case series of nine patients with bullous keratopathy who underwent UT-DSAEK using 200 mmHg ICP during graft preparation are reported.

Results

Laboratory outcomes showed 2 ± 1% and 2 ± 2% dead cells following 70 mmHg and 200 mmHg ICP respectively. Percentage viability in the 70 mmHg group (52.94 ± 5.88%) was not found to be significantly different (p = 0.7) compared to the 200 mmHg group (59.14 ± 10.43%). The mean corneal thinning rate after applying 200 mmHg ICP was 27 ± 13 μm/min centrally (7.2%/min). In the clinical case series, two cases were combined with cataract surgery. Re-bubbling rate was 11%. At the last follow-up (259 ± 109 days), graft thickness was 83 ± 22 μm centrally, endothelial cell density was 1175 ± 566 cell/mm2 and the BCVA of 0.08 ± 0.12 logMAR was recorded with no episodes of rejection.

Conclusion

ACP control unit for UT-DSAEK graft preparation helps in consistently obtaining UT-DSAEK grafts without compromising endothelial cell viability.

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Data availability

All the raw data are available in the FBOV repository.

References

  1. Stuart AJ, Romano V, Virgili G, Shortt AJ (2018) Descemet’s membrane endothelial keratoplasty (DMEK) versus Descemet’s stripping automated endothelial keratoplasty (DSAEK) for corneal endothelial failure. Cochrane Database Syst Rev 6:CD012097

    PubMed  Google Scholar 

  2. Ruzza A, Parekh M, Salvalaio G et al (2015) (2015) Bubble technique for Descemet membrane endothelial keratoplasty tissue preparation in an eye bank: air or liquid? Acta Ophthalmol 93:e129-134

    Article  Google Scholar 

  3. Busin M, Albé E (2014) Does thickness matter: ultrathin Descemet stripping automated endothelial keratoplasty. Curr Opin Ophthalmol 25:312–318

    Article  Google Scholar 

  4. Dickman MM, Cheng YY, Berendschot TT, van den Biggelaar FJ, Nuijts RM (2013) Effects of graft thickness and asymmetry on visual gain and aberrations after Descemet stripping automated endothelial keratoplasty. JAMA Ophthalmol 131:737–744. Erratum in: JAMA Ophthalmol 131:1102

    Article  Google Scholar 

  5. Gorovoy MS (2006) Descemet-stripping automated endothelial keratoplasty. Cornea 25:886–889

    Article  Google Scholar 

  6. Saunier V, Robinet Perrin A, Costet C, Touboul D (2016) Reproducibility of single-pass donor DSAEK tissue preparation with the MORIA single-use microkeratome. J Fr Ophtalmol 39:780–785

    Article  CAS  Google Scholar 

  7. Parekh M, Ruzza A, Steger B et al (2019) Cross-country transportation efficacy and clinical outcomes of preloaded large-diameter ultra-thin Descemet stripping automated endothelial keratoplasty grafts. Cornea 38:30–34

    Article  Google Scholar 

  8. Romano V, Steger B, Myneni J, Batterbury M, Willoughby CE, Kaye SB (2017) Preparation of ultrathin grafts for Descemet-stripping endothelial keratoplasty with a single microkeratome pass. J Cataract Refract Surg 43:12–15

    Article  Google Scholar 

  9. Parekh M, Peh G, Mehta JS et al (2019) Passaging capability of human corneal endothelial cells derived from old donors with and without accelerating cell attachment. Exp Eye Res 189:107814

    Article  CAS  Google Scholar 

  10. Parekh M, Romano V, Ruzza A et al (2019) Culturing discarded peripheral human corneal endothelial cells from the tissues deemed for preloaded DMEK transplants. Cornea 38:1175–1181

    Article  Google Scholar 

  11. Romano V, Steger B, Chen JY et al (2015) Reliability of the effect of artificial anterior chamber pressure and corneal drying on corneal graft thickness. Cornea 34:866–869

    Article  Google Scholar 

  12. Romano V, Parekh M, Ruzza A et al (2018) Comparison of preservation and transportation protocols for preloaded Descemet membrane endothelial keratoplasty. Br J Ophthalmol 102:549–555

    Article  Google Scholar 

  13. Romano V, Tey A, Hill NM et al (2015) Influence of graft size on graft survival following Descemet stripping automated endothelial keratoplasty. Br J Ophthalmol 99:784–788

    Article  Google Scholar 

  14. Melamed S, Ben-Sira I, Ben-Shaul Y (1980) Corneal endothelial changes under induced intraocular pressure elevation: a scanning and transmission electron microscopic study in rabbits. Br J Ophthalmol 64:164–169

    Article  CAS  Google Scholar 

  15. Bhogal MS, Allan BD (2012) Graft profile and thickness as a function of cut transition speed in Descemet-stripping automated endothelial keratoplasty. J Cataract Refract Surg 38:690–695

    Article  Google Scholar 

  16. Thomas PBM, Mukherjee AN, O’Donovan D, Rajan MS (2013) Preconditioned donor corneal thickness for microthin endothelial keratoplasty. Cornea 7:e173-178

    Article  Google Scholar 

  17. Ide T, Yoo SH, Kymionis GD et al (2008) Descemet-stripping automated endothelial keratoplasty: effect of anterior lamellar corneal tissue-on/-off storage condition on Descemet-stripping automated endothelial keratoplasty donor tissue. Cornea 27:754–757

    Article  Google Scholar 

  18. Nishisako S, Aoki D, Sasaki C, Higa K, Shimazaki J (2018) Comparison of artificial anterior chamber internal pressures and cutting systems for Descemet’s stripping automated endothelial keratoplasty. Transl Vis Sci Technol 7:11

    Article  Google Scholar 

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Authors and Affiliations

  1. International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Via Padiglione Rama, Zelarino, 30174, Venice, Italy

    Alessandro Ruzza, Mohit Parekh, Gabriela Wojcik, Stefano Ferrari & Diego Ponzin

  2. Institute of Ophthalmology, University College London, London, UK

    Mohit Parekh

  3. Unita Operativa Oculistica Di Ravenna, Azienda USL Della Romagna, Emilia Romagna, Italy

    Luca Avoni

  4. Moria Surgical, Antony, France

    Ludovic Desneux

  5. Department of Eye and Vision Science, University of Liverpool, Liverpool, UK

    Hannah J. Levis & Vito Romano

  6. Department of Ophthalmology, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, UK

    Vito Romano

  7. Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion on Oftalmologica, Oviedo, Spain

    Vito Romano

Authors
  1. Alessandro Ruzza
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  2. Mohit Parekh
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  3. Luca Avoni
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  4. Gabriela Wojcik
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  5. Stefano Ferrari
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  6. Ludovic Desneux
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  7. Diego Ponzin
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  8. Hannah J. Levis
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  9. Vito Romano
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Contributions

1. Substantial contributions to:

a) Conception and design—AR, LA, LD, DP, VR

b) Acquisition of data—AR, MP, GW, LA, HL

c) Analysis—AR, MP, GW, LA, SF, HL

d) Interpretation of data—AR, MP, GW, LA, LD, HL, DP, SF, VR

2. Drafting the article or revising it critically for important intellectual content—AR, MP, GW, LA, LD, HL, DP, SF, VR

3. Final approval of the version to be published—AR, MP, GW, LA, LD, HL, DP, SF, VR

Corresponding author

Correspondence to Alessandro Ruzza.

Ethics declarations

Consent to participate

For laboratory study, consent from the donor’s next-of-kin was obtained for the tissues to be used for research. For clinical study, consent from the patient was obtained before surgery.

Competing interests

The authors declare no competing interests.

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Ruzza, A., Parekh, M., Avoni, L. et al. Ultra-thin DSAEK using an innovative artificial anterior chamber pressuriser: a proof-of-concept study. Graefes Arch Clin Exp Ophthalmol 259, 1871–1877 (2021). https://doi.org/10.1007/s00417-021-05194-0

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  • DOI: https://doi.org/10.1007/s00417-021-05194-0

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