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Modified procedure for Loading "Flat" DMEK Grafts Into an Injector.

Megan M W Straiko¹, Philip K Dye¹, Matthew T Hikes¹

¹Lions VisionGift, Portland, OR; and.

|October 8, 2021

Summary

A new drop-in method for loading Descemet membrane endothelial keratoplasty (DMEK) grafts shows no significant difference in endothelial cell loss (ECL) compared to the standard suction technique, offering a viable alternative for graft preparation.

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Area of Science:

Ophthalmology
Corneal Surgery
Tissue Engineering

Background:

Descemet membrane endothelial keratoplasty (DMEK) is a surgical procedure to restore vision by replacing damaged endothelium.
Endothelial cell loss (ECL) is a critical factor affecting graft survival and visual outcomes in DMEK.
Current graft loading techniques, such as the standard suction procedure, can be associated with varying degrees of ECL and potential tissue damage.

Purpose of the Study:

To compare the endothelial cell loss (ECL) in Descemet membrane endothelial keratoplasty (DMEK) grafts loaded using a novel drop-in procedure versus the standard suction procedure.
To evaluate potential graft damage, such as grab marks, associated with the drop-in loading method.

Main Methods:

Donor corneas were paired, with one graft from each pair loaded using the standard suction protocol and the other using a drop-in protocol.
The drop-in protocol involved gently grasping the graft edge with forceps and dropping it into the injector.
Grafts were subsequently assessed for endothelial cell loss (ECL) and examined for any loading-induced damage.

Main Results:

No statistically significant difference was observed in the mean ECL between grafts loaded with the drop-in protocol (19.5% ± 4.8%) and those loaded with the standard suction protocol (20.6% ± 4.5%).
The drop-in loading protocol did not consistently result in identifiable grab marks or other tissue damage when assessed by a trained corneal surgeon.

Conclusions:

The drop-in loading procedure for DMEK grafts is comparable to the standard suction method in terms of endothelial cell loss.
This technique may be particularly beneficial for surgeons and eye bank technicians managing difficult-to-handle DMEK grafts, such as flat or loosely scrolled tissues.