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Endothelium‐in versus endothelium‐out for Descemet membrane endothelial keratoplasty graft preparation and implantation
Author(s) -
Parekh Mohit,
Ruzza Alessandro,
Ferrari Stefano,
Ahmad Sajjad,
Kaye Stephen,
Ponzin Diego,
Romano Vito
Publication year - 2017
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.13162
Subject(s) - corneal endothelium , endothelium , descemet membrane , endothelial stem cell , ophthalmology , medicine , transplantation , surgery , phosphate buffered saline , cornea , chemistry , in vitro , chromatography , biochemistry
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.