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Prestained and Preloaded DMEK Grafts: An Evaluation of Tissue Quality and Stain Retention

Zeidenweber, Dorian A. MD*; Tran, Khoa D. PhD; Sales, Christopher S. MD; Wehrer, Stephen W. CEBT; Straiko, Michael D. MD*; Terry, Mark A. MD*,†

doi: 10.1097/ICO.0000000000001329
Basic Investigation

Purpose: To examine endothelial cell damage and stain retention of prestained preloaded Descemet membrane endothelial keratoplasty (DMEK) grafts.

Methods: DMEK grafts were stained with trypan blue or left unstained before loading into a Straiko modified Jones tube. A protocol to stain preloaded grafts inside the modified Jones tube and resulting cell loss was also examined. Endothelial cell loss was determined by vital dye staining after 3 days of cold storage and compared between the 3 groups. Eight additional grafts were stained, loaded, and shipped from Oregon to New York to assess stain stability. Stain retention and the ability to successfully inject and open these “prestained preloaded” grafts in cadaveric donor eyes were also evaluated.

Results: Unstained preloaded DMEK grafts showed an overall cell loss of 15% ± 3% [95% confidence interval (CI), 11%–18%]. Prestained grafts had a cell loss of 16% ± 4% (95% CI, 10%–22%) and were not significantly different from unstained grafts (P = 1). Grafts stained while inside the modified Jones tubes had an average cell loss of 18% ± 2% (95% CI, 16%–20%, P prestained = 0.15, P unstained = 0.09). All grafts shipped across the country and examined 3 days after preparation showed a decrease in stain intensity but were still deemed suitable for transplantation by an experienced DMEK surgeon.

Conclusions: It is possible to prestain and preload DMEK grafts without inducing additional endothelial cell loss. Consideration should be given to the interval between staining and surgery because stain can fade.

Supplemental Digital Content is Available in the Text.

*Cornea Service, Devers Eye Institute, Portland, OR;

Vision Research Laboratory, Lions VisionGift, Portland, OR; and

Cornea and Refractive Service, Weill Cornell Medical College, New York, NY.

Reprints: Dorian A. Zeidenweber, MD, Cornea Service, Devers Eye Institute, 415 NW 21 Avenue, Suite 301, Portland, OR 97209 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received April 07, 2017

Received in revised form June 15, 2017

Accepted July 03, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.