Scrolling of the Donor Cornea in Dependence of Temperature and Osmolarity for Descemet Membrane Endothelial Keratoplasty

Abstract

Background After preparation of a graft for Descemet membrane endothelial keratoplasty (DMEK), the diameter of the graftʼs scroll varies significantly. In particular, narrow scrolls may complicate DMEK surgery. In this study we investigated how temperature, osmolarity, and deswelling of the donor tissue influence scrolling diameter.

Material and Methods In this study we examined donor corneas that could not be used for transplantation. The diameter of the DMEK donor scrolls was measured after graft preparation by reflected light microscopy under different conditions: (1) The diameter of the roll was measured in Ringerʼs solution at temperatures of 5 °C, 24 °C and 35 °C. (2) To study the effect of different culture conditions we used 6% dextran-containing medium for 10 min, 20 min, 16 h and 24 h, and hyper- and hypoosmolar fluids (5% NaCl or aqua dest) for 5 min each.

Results The median donors age was 62 years. The median endothelial cell density of the donor corneas was 1679 cells/mm². The median diameter of the DMEK scroll was 1.35 mm in Ringerʼs solution at 24 °C (IQR, 1.04 – 1.89). In Ringerʼs solution at different temperatures, the scrolling diameter changed between 0.02 mm and 0.29 mm. The change in osmolarity resulted in a difference of 0.02 mm to 0.46 mm. Deswelling with dextran resulted in a change of scrolling diameter between 0.02 mm and 0.09 mm.

Summary In this experimental case series, the diameter of the DMEK scroll did not change due to changes of temperature, osmolarity or deswelling. Influencing the graftʼs scroll to standardize and simplify the DMEK surgery remains an interesting goal for future studies.

Key words

corneal transplantation - DMEK - graft scrolling

Publication History

Received: 22 April 2020

Accepted: 16 July 2020

Article published online:
17 November 2020

• References/Literatur

• 1 Deng SX, Lee WB, Hammersmith KM. et al. Descemet Membrane Endothelial Keratoplasty: Safety and Outcomes: A Report by the American Academy of Ophthalmology. Ophthalmology 2018; 125: 295-310
• 2 Flockerzi E, Maier P, Böhringer D. et al. all German Keratoplasty Registry Contributors. Trends in Corneal Transplantation from 2001 to 2016 in Germany: A Report of the DOG-Section Cornea and its Keratoplasty Registry. Am J Ophthalmol 2018; 188: 91-98
• 3 Dapena I, Yeh RY, Baydoun L. et al. Potential causes of incomplete visual rehabilitation at 6 months postoperative after descemet membrane endothelial keratoplasty. Am J Ophthalmol 2013; 156: 780-788
• 4 Heinzelmann S, Böhringer D, Eberwein P. et al. Outcomes of Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty from a single centre study. Graefes Arch Clin Exp Ophthalmol 2016; 254: 515-522
• 5 Birbal RS, Ni Dhubhghaill S, Bourgonje VJA. et al. Five-Year Graft Survival and Clinical Outcomes of 500 Consecutive Cases After Descemet Membrane Endothelial Keratoplasty. Cornea 2020; 39: 290-297
• 6 Wacker K, Baratz KH, Maguire LJ. et al. Descemet Stripping Endothelial Keratoplasty for Fuchsʼ Endothelial Corneal Dystrophy: Five-Year Results of a Prospective Study. Ophthalmology 2016; 123: 154-160
• 7 Kruse FE, Schrehardt US, Tourtas T. Optimizing outcomes with Descemetʼs membrane endothelial keratoplasty. Curr Opin Ophthalmol 2014; 25: 325-334
• 8 Mohammed I, Ross A, Britton JO. et al. Elastin Content and Distribution in Endothelial Keratoplasty Tissue Determines Direction of Scrolling. Am J Ophthalmol 2018; 194: 16-25
• 9 Koo EH, Eghrari AO, Meshkin RS. et al. Effects of temperature and fluid media on the scroll width size of the Descemetʼs membrane endothelial keratoplasty (DMEK) donor graft. Clin Ophthalmol 2017; 11: 1611-1615
• 10 Schlötzer-Schrehardt U, Bachmann BO, Tourtas T. et al. Reproducibility of graft preparations in Descemetʼs membrane endothelial keratoplasty. Ophthalmology 2013; 120: 1769-1777
• 11 Kruse FE, Laaser K, Cursiefen C. et al. A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea 2011; 30: 580-587
• 12 Akbaba Y, Weller JM, Rössler K. et al. “Bubble-in-the-Roll” Technique Using the Endoject DMEK Injector: Influence of the Air Bubble on Endothelial Cell Loss. Cornea 2017; 36: 1576-1579
• 13 Kobayashi A, Yokogawa H, Mori N. et al. Development of a Donor Tissue Holding Technique for Descemetʼs Membrane Endothelial Keratoplasty Using a 25-Gauge Graft Manipulator. Case Rep Ophthalmol 2018; 9: 431-438