Stamping an S on DMEK Donor Tissue to Prevent Upside-Down Grafts: Laboratory Validation and Detailed Preparation Technique Description

Purpose: To report endothelial cell loss (ECL) caused by a novel S-stamp preparation technique for Descemet membrane endothelial keratoplasty (DMEK). Methods: Six cadaveric human corneas were prepared for DMEK transplantation using a single standardized technique, including the application of a dry ink gentian violet S-stamp to the stromal side of Descemet membrane. Endothelial cell death was evaluated and quantified using computerized analysis of vital dye staining. Results: ECL caused by the S-stamp was 0.6% (range 0.1%–1.0%), which comprised less than one-tenth of the total ECL caused by our preparation of the DMEK graft from the start to finish, including recovery, prestripping, S-stamping, and trephination (13.7% total ECL, range 9.9%–17.6%). Conclusions: Our novel S-stamp donor tissue preparation technique is intuitive to learn and holds the promise of preventing iatrogenic primary graft failure due to upside-down grafts without causing unacceptable increases in ECL.

[1]  Z. M. Mayko,et al.  Standardized DMEK Technique: Reducing Complications Using Prestripped Tissue, Novel Glass Injector, and Sulfur Hexafluoride (SF6) Gas , 2015, Cornea.

[2]  Christopher G. Stoeger,et al.  Risk factors for eye bank preparation failure of Descemet membrane endothelial keratoplasty tissue. , 2015, American journal of ophthalmology.

[3]  Christopher G. Stoeger,et al.  Imaging and Quantification of Endothelial Cell Loss in Eye Bank Prepared DMEK Grafts Using Trainable Segmentation Software , 2014, Current eye research.

[4]  A. Agarwal,et al.  Endoilluminator–assisted transcorneal illumination for Descemet membrane endothelial keratoplasty: Enhanced intraoperative visualization of the graft in corneal decompensation secondary to pseudophakic bullous keratopathy , 2014, Journal of cataract and refractive surgery.

[5]  K. Bartz-Schmidt,et al.  Clinical and ultrastructural results after denudation of the posterior stroma for an autologous descemet membrane endothelial keratoplasty in the fellow eye. , 2014, Cornea.

[6]  K. Bartz-Schmidt,et al.  Histological and ultrastructural findings of corneal tissue after failed descemet membrane endothelial keratoplasty , 2014, Acta ophthalmologica.

[7]  Marianne O Price,et al.  Handheld Slit Beam Techniques to Facilitate DMEK and DALK , 2013, Cornea.

[8]  Christopher G. Stoeger,et al.  The Endothelial Safety of Using a Gentian Violet Dry-Ink “S” Stamp for Precut Corneal Tissue , 2012, Cornea.

[9]  F. Kruse,et al.  Descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty. , 2012, American journal of ophthalmology.

[10]  Laurence E. Frank,et al.  Prevention and management of graft detachment in descemet membrane endothelial keratoplasty. , 2012, Archives of ophthalmology.

[11]  Marianne O Price,et al.  Risk of corneal transplant rejection significantly reduced with Descemet's membrane endothelial keratoplasty. , 2012, Ophthalmology.

[12]  I. Dapena,et al.  Incidence of Early Allograft Rejection After Descemet Membrane Endothelial Keratoplasty , 2011, Cornea.

[13]  F. Horn,et al.  Donor tissue culture conditions and outcome after descemet membrane endothelial keratoplasty. , 2011, American journal of ophthalmology.

[14]  U. Schlötzer-Schrehardt,et al.  A Stepwise Approach to Donor Preparation and Insertion Increases Safety and Outcome of Descemet Membrane Endothelial Keratoplasty , 2011, Cornea.

[15]  K. Droutsas,et al.  Standardized "no-touch" technique for descemet membrane endothelial keratoplasty. , 2011, Archives of ophthalmology.

[16]  F. Price,et al.  Descemet's membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival. , 2009, Ophthalmology.

[17]  I. Dapena,et al.  Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases , 2009, Eye.

[18]  M. B. Goren.  The Eye Bank Association of America. , 2006, Comprehensive ophthalmology update.