We describe a rapid and easy technique for the preparation of pre-stripped Descemet membrane (DM) endothelial keratoplasty (DMEK) tissue in the eye bank, without the use of dye or trephining by the eye bank technician. After drawing 2 radial marks 90° apart on the scleral rim of the cornea, a circumferential incision was made internal to the trabecular meshwork and the edge of the DM opposite to the marked area was scored and gently peeled towards the marked area. Finally, the peeled DM was gently unrolled and attached to the posterior stromal bed via absorbing excess liquid from the periphery. The prepared DMEK tissue while reattached on the posterior aspect of the cornea was subjected to slit-lamp biomicroscopic and specular microscopic examinations. In case of proper preparation of DMEK tissue and suitability of endothelial cells for DMEK surgery, the tissue was distributed for transplantation. At the time of surgery, trypan blue staining was performed by the cornea surgeon before DM trephination. Duration of DMEK tissue preparation, uneventful preparation, post-preparation endothelial cell loss, surgeon’s satisfaction, and intra- and post-operative attachment of the tissue were investigated variables in this study. Over a 2-year period, 28 DMEK tissues were successfully prepared from 30 corneas using our new technique. The median duration of DMEK preparation was 100 s. The area of endothelial cell loss was 1.8% ± 1.2% centrally and 6.2% ± 1.8% in areas close to the forceps contacts. Seven out of the 28 (25%) DMEK tissues were ruined by surgeons during surgery and the overall rate of re-bubbling in 19 transplanted DMEK tissues was 16%. The presented method, which uses no trephining or vital dye, has simplified and expedited the preparation process of pre-stripped DMEK tissue in the eye banks.
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Ang M, Wilkins MR, Mehta JS, Tan D (2016) Descemet membrane endothelial keratoplasty. Br J Ophthalmol 100(1):15–21
Anshu A, Price MO, Price FW Jr (2012) Risk of corneal transplant rejection significantly reduced with Descemet’s membrane endothelial keratoplasty. Ophthalmology 119:536–540
Baydoun L, Ham L, Borderie V, Dapena I, Hou J, Frank LE, Oellerich S, Melles GR (2015) Endothelial survival after Descemet membrane endothelial keratoplasty: effect of surgical indication and graft adherence status. JAMA Ophthalmol 133(11):1277–1285
Birbal RS, Sikder S, Lie JT, Groeneveld-van Beek EA, Oellerich S, Melles GRJ (2018) Donor tissue preparation for Descemet membrane endothelial keratoplasty: an updated review. Cornea 37(1):128–135
Boynton GE, Woodward MA (2014) Eye-bank preparation of endothelial tissue. Curr Opin Ophthalmol 25(4):319–324
Brennan K (2019) DMEK Success: maintaining the graft. Rev Ophthalmol. https://www.reviewofophthalmology.com/article/dmek-success-maintaining-the-graft. Published 5 Feb 2019
Brissette A, Conlon R, Teichman JC, Yeung S, Ziai S, Baig K (2015) Evaluation of a new technique for preparation of endothelial grafts for descemet membrane endothelial keratoplasty. Cornea 34(5):557–559
Busin M, Scorcia V, Patel AK, Salvalaio G, Ponzin D (2010) Pneumatic dissection and storage of donor endothelial tissue for Descemet’s membrane endothelial keratoplasty: a novel technique. Ophthalmology 117:1517–1520
Camposampiero D, Tiso R, Zanetti E, Ruzza A, Bruni A, Ponzin D (2003) Improvement of human corneal endothelium in culture after prolonged hypothermic storage. Eur J Ophthalmol 13(9–10):745–751
Dapena I, Ham L, Droutsas K, van Dijk K, Moutsouris K, Melles GR (2011) Learning curve in Descemet’s membrane endothelial keratoplasty: first series of 135 consecutive cases. Ophthalmology 118(11):2147–2154
Feng MT, Burkhart ZN, Price FW, Price MO (2013) Effect of donor preparation-touse times on Descemet membrane endothelial keratoplasty outcomes. Cornea 3(32):1080–1082
Filev F, Oezcan C, Feuerstacke J, Linke SJ, Wulff B, Hellwinkel OJ (2017) Semi-quantitative assessments of dextran toxicity on corneal endothelium: conceptual design of a predictive algorithm. Cell Tissue Bank 18(1):91–98
Groeneveld-van Beek EA, Lie JT, van der Wees J, Bruinsma M, Melles GR (2013) Standardized “no-touch” donor tissue preparation for DALK and DMEK: harvesting undamaged anterior and posterior transplants from the same donor cornea. Acta Ophthalmol 91:145–150
Guerra F, Anshu A, Price M, Price F (2011) Endothelial Keratoplasty: fellow eyes comparison of Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty. Cornea 30(12):1382–1386
Heinzelmann S, Huther S, Bohringer D, Eberwein P, Reinhard T, Maier P (2014) Influence of donor characteristics on Descemet membrane endothelial keratoplasty. Cornea 33(6):644–648
Heinzelmann S, Böringer D, Eberwein P, Reinhard T, Maier P (2017) Graft dislocation and graft failure following Descemet membrane endothelial keratoplasty (DMEK) using precut tissue: a retrospective cohort study. Graefes Arch Clin Exp Ophthalmol 255:127–133
John T, Patel A, Vasavada A, Singh M, Nath V, Cheng AM, Sheha H (2016) Effect of trypan blue on descemet membrane elasticity. Cornea 35(11):1401–1403
Majmudar PA, Johnson L (2017) Enhancing DMEK success by identifying optimal levels of trypan blue dye application to donor corneal tissue. Cornea 36(2):217–221
Muraine M, Gueudry J, He Z, Piselli S, Lefevre S, Toubeau D (2013) Novel technique for the preparation of corneal grafts for Descemet membrane endothelial keratoplasty. Am J Ophthalmol 156:851–859
Parekh M, Baruzzo M, Favaro E, Borroni D, Ferrari S, Ponzin D, Ruzza A (2017) Standardizing Descemet membrane endothelial keratoplasty graft preparation method in the eye bank-experience of 527 Descemet membrane endothelial keratoplasty tissues. Cornea 36(12):1458–1466
Pereira NC, Forseto ADS, Santos MSD, Grottone G, Santos A, Gomes JÁP (2018) Descemet’s membrane endothelial keratoplasty with a simplified technique and low complication rate: the samba technique. Arq Bras Oftalmol 81(2):130–136
Price MO, Giebel AW, Fairchild KM, Price FW Jr (2009) Descemet’s membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival. Ophthalmology 116:2361–2368
Regnier M, Auxenfans C, Maucort-Boulch D, Marty AS, Damour O, Burillon C, Kocaba V (2017) Eye bank prepared versus surgeon cut endothelial graft tissue for Descemet membrane endothelial keratoplasty: an observational study. Medicine (Baltimore) 96(19):e6885
Tausif HN, Johnson L, Titus M, Mavin K, Chandrasekaran N, Woodward MA, Shtein RM, Mian SI (2014) Corneal donor tissue preparation for Descemet’s membrane endothelial keratoplasty. J Vis Exp 91:51919
Tourtas T, Laaser K, Bachmann BO, Cursiefen C, Kruse FE (2012) Descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 153:1082–1090
Tzamalis A, Romano V, Kaye SB (2018) Standardizing the Descemet membrane endothelial keratoplasty graft preparation method in the eye bank-experience of 527 Descemet membrane endothelial keratoplasty tissues: a proposed modification. Cornea 37(5):e26–e27
Weber IP, Rana M, Thomas PBM, Dimov IB, Franze K, Rajan MS (2017) Effect of vital dyes on human corneal endothelium and elasticity of Descemet’s membrane. PLoS ONE 12(9):e0184375
Zarei-Ghanavati S, Khakshoor H, Zarei-Ghanavati M (2010) Reverse big bubble: a new technique for preparing donor tissue of Descemet membrane endothelial keratoplasty. Br J Ophthalmol 94:1110–1111
Zhao M, Campolmi N, Thuret G, Piselli S, Acquart S, Peoc’h M, Gain P (2012) Poloxamines for deswelling of organ-cultured corneas. Ophthalmic Res 48(3):124–133
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Chamani, T., Javadi, M.A. & Kanavi, M.R. Trephine- and dye-free technique for eye bank preparation of pre-stripped Descemet membrane endothelial keratoplasty tissue. Cell Tissue Bank 20, 321–326 (2019). https://doi.org/10.1007/s10561-019-09771-w
- Descemet membrane endothelial keratoplasty