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Negative impact of dextran in organ culture media for pre-stripped tissue preservation on DMEK (Descemet membrane endothelial keratoplasty) outcome

  • Cornea
  • Published:
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Abstract

Purpose

To assess the morphological and functional outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed with pre-stripped tissue preserved in organ culture medium containing dextran compared to tissue preserved in dextran-free medium.

Methods

In this retrospective study, we reviewed the clinical records of 103 patients who underwent DMEK surgery with pre-stripped tissue in our department between June 2015 and September 2016. The endothelium-Descemet membrane layer was preserved in organ culture medium for a maximum of 48 h for all patients. For group 1, 49 endothelium-Descemet membrane (EDM) were stripped and preserved in medium 1 (dextran-free organ culture medium), while 54 EDM were stripped and preserved in medium 2 (organ culture medium supplemented with 6% dextran T-500) for group 2. Outcome measures included best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) of all eyes in both groups at three consecutive postoperative time points: 2 weeks, 6 weeks, and 6 months postoperatively. We also compared the repeat keratoplasty rates between the groups.

Results

Group 1 showed a statistically significant better BCVA compared to group 2 at each time point (p < 0.05). The percentage of grafts achieving 0.5 or better after 6 months in group 1 was 96% and in group 2, it was 66% (P < 0.001). CCT was significantly lower in group 1 compared to group 2 at 2 weeks and 6 months after surgery (p < 0.05). ECD was comparable between donor grafts before surgery but was significantly greater in groups 1 after 2 and 6 weeks (p < 0.05), but not after 6 months. Necessity for repeat keratoplasty (repeat DMEK, subsequent penetrating keratoplasty (PKP)) was significantly lower in group 1 (p < 0.05).

Conclusions

Pre-stripped tissue for DMEK preserved in dextran-free medium led to better visual recovery, thinner postoperative corneas, a higher endothelial cell density, and a lower rate of repeat keratoplasty, indicating that dextran has an unfavorable impact on the preservation of pre-stripped DMEK tissue.

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Authors and Affiliations

  1. Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany

    Alaadin Abdin, Loay Daas, Max Pattmöller, Shady Suffo & Berthold Seitz

  2. Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany

    Achim Langenbucher

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  1. Alaadin Abdin
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  2. Loay Daas
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  3. Max Pattmöller
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  5. Achim Langenbucher
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Correspondence to Alaadin Abdin.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Abdin, A., Daas, L., Pattmöller, M. et al. Negative impact of dextran in organ culture media for pre-stripped tissue preservation on DMEK (Descemet membrane endothelial keratoplasty) outcome. Graefes Arch Clin Exp Ophthalmol 256, 2135–2142 (2018). https://doi.org/10.1007/s00417-018-4088-4

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  • DOI: https://doi.org/10.1007/s00417-018-4088-4

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