Basic InvestigationInk Retention and Endothelial Cell Viability After the Application of an Orientation Stamp Over an Air Bubble During Descemet Membrane Endothelial Keratoplasty Graft PreparationStraiko, Megan M. W. PhD; Odell, Kelly BS; Dye, Philip K. CEBT; Hikes, Matthew T. BA; Andersen, Allison BS, CEBT; Trolli, Giulia BS; Tsering, Dolkar T. BS; Galloway, Joshua D. BS, CEBT; Tran, Khoa D. PhDAuthor Information Lions VisionGift, Portland, OR and Boston, MA. Correspondence: Megan M. W. Straiko, PhD, Lions VisionGift, 2201 SE 11th Avenue, Portland, OR 97214 (e-mail: [email protected]). 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 (www.corneajrnl.com). Cornea: July 2021 - Volume 40 - Issue 7 - p 894-898 doi: 10.1097/ICO.0000000000002590 Buy SDC Metrics Abstract Purpose: To investigate stamp visibility and endothelial cell loss (ECL) after the application of an orientation mark to Descemet membrane endothelial keratoplasty (DMEK) grafts supported by an air bubble. Methods: Eighteen DMEK grafts were prepared at an eye bank using a technique where an orientation mark was applied to the stromal surface of a DMEK graft that was supported by a small air bubble placed at the edge of the 2 endothelial surfaces of the graft. Grafts were evaluated at 2 and 5 days for stamp visibility and at 5 days with calcein-AM staining for ECL. Nine grafts underwent cross-country shipping, and the ECL of shipped and nonshipped grafts was compared using unpaired t test. Results: All 18 DMEK grafts exhibited a single, solid, readily visible orientation mark 2 and 5 days after preparation with a mean ECL of 13.5% ± 4.9%. Shipping conditions had no effect on stain retention or ECL. Conclusions: The application of an orientation stamp to a DMEK graft over an air bubble in an eye bank setting results in a single, solid orientation mark that is readily visible within the period in which most eye bank-prepared tissue is used. This technique produces no further ECL compared with the methods where the orientation stamp is applied through a stromal window. Eye bank technicians and surgeons can be confident that this modified preparation technique results in transplant-quality DMEK grafts with the additional benefit of conserving the stromal cap for use in other anterior lamellar procedures, thereby making efficient use of donor tissue. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.