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Evaluation and Quality Assessment of Prestripped, Preloaded Descemet Membrane Endothelial Keratoplasty Grafts

Tran, Khoa D. PhD; Dye, Philip K. CEBT; Odell, Kelly BS; Galloway, Joshua CEBT; Stoeger, Christopher G. MBA, CEBT; Straiko, Michael D. MD; Terry, Mark A. MD

doi: 10.1097/ICO.0000000000001150
Basic Investigation

Purpose: To determine graft quality and feasibility of Descemet membrane endothelial keratoplasty (DMEK) grafts that are prestripped and preloaded into injectors by eye bank technicians before shipping to surgeons.

Methods: DMEK grafts (n = 31) were prepared from donor corneas and preloaded into Straiko Modified Jones tubes and set inside viewing chambers filled with 20 mL of Optisol-GS. Preloaded grafts were evaluated using specular microscopy and slit-lamp biomicroscopy. Endothelial cell loss (ECL) was captured by vital dye staining and quantified using FIJI. A subset of preloaded tissues was subjected to a shipping validation and 5-day storage assay. Fourteen additional DMEK grafts (not preloaded) were examined to quantify damage resulting from prestripping alone.

Results: Specular microscopy was able to be performed for all preloaded tissues. Average ECL for preloaded tissues quantified by vital dye staining and FIJI after overnight storage was 16.8% ± 5.9%, and differed from slit-lamp ECL estimation by an average of 5.3% ± 3.6%. The average damage caused by prestripping alone was 9.3% ± 5.9%, and it was significantly less than that of preloaded tissues (P < 0.01). Average ECL for preloaded tissues subjected to round-trip shipping events was 18.5% ± 12.4%, and ECL for tissues stored at 4°C for 5 days after preloading was 13.1% ± 9.5%.

Conclusions: It is possible to prepare, evaluate, and ship DMEK grafts loaded inside a glass carrier and viewing chamber. The ability to evaluate tissues after processing allows for adherence to the Eye Bank Association of America Medical Standards, and for surgeons to receive the most accurate tissue information.

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

Cornea Service, Devers Eye Institute, Portland, OR.

Reprints: Khoa D. Tran, PhD, Lions VisionGift, 2201 SE 11th Avenue, Portland, OR 97214 (e-mail:

K. D. Tran, P. K. Dye, K. Odell, J. Galloway, and C. G. Stoeger are employees of Lions VisionGift and may have financial conflicts. Lions VisionGift holds a provisional patent on the method of storing and evaluating preloaded Descemet membrane endothelial keratoplasty grafts as described in this article. The remaining authors have no funding or conflicts of interest to disclose.

P. K. Dye and K. Odell contributed equally to this work.

All authors met the criteria for authorship.

Received November 03, 2016

Received in revised form December 05, 2016

Accepted December 07, 2016

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