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Preloaded Descemet Membrane Endothelial Keratoplasty Donor Tissue: Surgical Technique and Early Clinical Results

Newman, Lara R., MD*; DeMill, David L., MD*; Zeidenweber, Dorian A., MD*; Mayko, Zachary M., MS; Bauer, Alex J., BS; Tran, Khoa D., PhD; Straiko, Michael D., MD*,†; Terry, Mark A., MD*,†

doi: 10.1097/ICO.0000000000001646
Clinical Science

Purpose: To describe the technique, advantages, and early complication rates of using Descemet membrane endothelial keratoplasty (DMEK) donor tissue that is prestained and preloaded into an injector at the eye bank and delivered in a storage medium to the surgeon for transplantation 1 to 2 days later.

Methods: A total of 111 eyes with endothelial failure underwent DMEK using donors that were prestripped, prestained, S-stamped, and preloaded into a Straiko modified Jones tube and delivered in an Optisol-filled viewing chamber 1 to 2 days later. Scroll tightness, time to unscroll and center the tissue, postoperative rebubble rate, and graft failure rate were recorded. Endothelial cell density was measured at 3 and 6 months.

Results: All tissues remained well stained with easy visualization at the time of surgery (n = 111). The mean scroll tightness was 2.2 (range: 1–4). The mean time to center and unscroll the tissue was 3.5 minutes (range: 0.5–11.25 min). There was no primary graft failure. There were 16 cases with the placement of another bubble postoperatively (with a 14.4% rebubble rate). Of those 16 cases, 2 required a second rebubble. Endothelial cell loss at 3 and 6 months postoperatively was 26.7% (n = 63 eyes) and 30.9% (n = 67 eyes), respectively.

Conclusions: This is the first report of the clinical use of prestained, preloaded tissue for DMEK. The characteristics and handling of the tissue were not different from those of surgeon-loaded tissue. Because punching, staining, and loading the graft intraoperatively is not necessary, the surgery time and risk of damaging donor tissue are reduced when using preloaded tissue.

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

Lions VisionGift, Portland, OR.

Correspondence: Lara R. Newman, MD, Cornea Service, Devers Eye Institute, 1040 NW 22nd Avenue, Suite 200, Portland, OR 97210 (e-mail:

This work was supported by a Richard Lindstrom Research Grant from the Eye Bank Association of America (EBAA).

The authors have no conflicts of interest to disclose.

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Off-label use: SF6 gas, trypan blue, Straiko modified Jones glass tube.

Received January 16, 2018

Received in revised form April 04, 2018

Accepted April 07, 2018

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