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Preloading Trifolded Grafts for Descemet Membrane Endothelial Keratoplasty Affects Scroll Formation
Steven J Solar1, Shiva Deljookorani2, Batya G Wiener1
1Department of Biomechanical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD.
Cornea
|March 3, 2020
Summary
Preloading Descemet membrane endothelial keratoplasty (DMEK) grafts for 48 hours significantly reduces their tendency to scroll after insertion. This technique improves handling and insertion of DMEK tissue.
Area of Science:
- Ophthalmology
- Biomedical Engineering
- Corneal Surgery
Background:
- Descemet membrane endothelial keratoplasty (DMEK) is an advanced endothelial keratoplasty technique.
- The endothelium-in, trifolded approach facilitates DMEK tissue insertion.
- Graft scrolling is a common challenge during DMEK procedures.
Purpose of the Study:
- To investigate the effect of preloading trifolded DMEK grafts for 48 hours on their scrolling tendency.
- To determine if prolonged preloading reduces biomechanical changes that cause graft scrolling.
Main Methods:
- Ten Descemet membrane grafts were prepared and trifolded.
- Grafts were preloaded in a DMEK cartridge for 48 hours or loaded instantly.
- Scrolling was assessed over 2 minutes, and scroll width was measured.
- A paired t test compared scrolling between preloaded and instantly loaded grafts.
Main Results:
- All grafts exhibited scrolling after removal from the cartridge.
- Preloaded grafts showed significantly less scrolling (4.02 mm) compared to instantly loaded grafts (2.91 mm) at all measured time points.
- The difference in scroll width was statistically significant (P = 0.035).
Conclusions:
- Preloading DMEK grafts in a trifolded configuration for 48 hours effectively reduces their scrolling tendency.
- This preloading method offers a potential solution to improve DMEK graft handling and surgical outcomes.
- Further research may explore optimal preloading durations and conditions.
