Mohit Parekh1, Alessandro Ruzza1, Stefano Ferrari1, Sajjad Ahmad2,3, Stephen Kaye2,3, Diego Ponzin1, Vito Romano2,3. 1. International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Venice, Italy. 2. Institue of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK. 3. St Paul's Eye Unit, Department of Eye and Vision Science, Royal Liverpool University Hospital, Liverpool, UK.
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.
RCT Entities:
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 humandonor 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.
Authors: Kali Barnes; Eric Chiang; Conan Chen; John Lohmeier; Jason Christy; Akash Chaurasia; Allison Rosen; Parth Vora; Stephanie Cai; Anshul Subramanya; Nicholas Durr; Robert Allen; Allen Omid Eghrari Journal: Cornea Date: 2019-03 Impact factor: 2.651
Authors: Sezen Karakus; Mehrnaz Ighani; Puntakarn Noparat; Marjan Tofigh; Eric Chiang; Kali Barnes; Conan Y Chen; Tiffany S Liu; Allen O Eghrari Journal: Cornea Date: 2019-05 Impact factor: 2.651
Authors: Conan Chen; Steven Jared Solar; John Lohmeier; Staci Terrin; Satya Baliga; Batya Gold Wiener; Daniel Schouten Lewis; Eric Chiang; Kali Alexandra Barnes; Akash Chaurasia; Allen O Eghrari Journal: BMJ Open Ophthalmol Date: 2021-05-20