Purpose: To report the effect of varying donor preparation-to-use times on outcomes of Descemet membrane endothelial keratoplasty (DMEK).
Methods: Prospective interventional series. DMEK donor tissues prepared at a single center on the day of surgery (group 0), 1 day before the surgery (group 1), or 2 days before the surgery (group 2) were transplanted into 361 eyes for Fuchs dystrophy, pseudophakic bullous keratopathy, or graft failure, with or without combined cataract surgery. When prepared ahead, the donor tissue was stored in refrigerated corneal storage solution until use. Primary outcome measures were air reinjection rate, primary failure rate, and endothelial cell loss.
Results: Donor and recipient characteristics did not differ significantly between the groups. In groups 0, 1, and 2, the rate of failure to clear was 1.5%, 1.9%, and 2.8%, respectively (P = 0.78), and the rebubbling rate was 15%, 13%, and 14%, respectively, in the grafts that cleared successfully (P = 0.92). Median endothelial cell loss at 3 months was 28%, 29%, and 29%, respectively (P = 0.56).
Conclusions: Having DMEK donor tissue prepared in advance can be logistically advantageous. Tissue preparation in advance with storage for 1 or 2 days in corneal storage solution at 4°C was not associated with any significant difference in the primary failure rate, air reinjection rate, or endothelial cell loss compared with the same-day preparation. The maximum allowable preparation-to-use time and the effects, if any, of different storage media or transportation from off-site locations have yet to be determined for precut DMEK tissue.