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Updated: Jul 15, 2025
Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
Size and Shape Matter: Cell Viability of Preloaded Descemet Stripping Automated Endothelial Keratoplasty Grafts in
Megan M W Straiko1, Onkar B Sawant2, Rebecca Hubbs1
1VisionGift, Portland, OR.
Insights
Smaller carriers increase endothelial cell loss in Descemet stripping automated endothelial keratoplasty (DSAEK) grafts. Graft thickness also directly correlates with cell loss, particularly in narrow carriers.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Cell Biology
Background:
- Descemet stripping automated endothelial keratoplasty (DSAEK) is a surgical procedure for corneal transplantation.
- Endothelial cell loss (ECL) is a critical factor affecting graft survival and visual outcomes.
- Optimizing graft handling and carrier design is essential to minimize ECL.
Purpose of the Study:
- To evaluate the impact of different carrier sizes and shapes on endothelial cell loss (ECL) in preloaded DSAEK grafts.
- To compare ECL across three distinct carrier types: EndoGlide Ultrathin, Descemet membrane endothelial keratoplasty EndoGlide, and a Jones tube.
- To investigate the relationship between graft thickness and ECL within different carriers.
Main Methods:
- Thirty-six donor corneas were prepared for DSAEK and loaded into three carrier types with varying lumen sizes and shapes.
- Grafts were stored in specific preservation solutions (Optisol-GS or Life4C) for defined periods.
- Endothelial cell viability was assessed using Calcein AM staining, followed by imaging and ECL analysis via FIJI segmentation.
- Statistical analysis included one-way ANOVA and Tukey post hoc tests to determine significance.
Main Results:
- No significant differences in donor characteristics were observed across the groups.
- The EndoGlide Ultrathin carrier (larger lumen) showed the lowest ECL (10.3% ± 2.3%).
- The Descemet membrane endothelial keratoplasty EndoGlide and Jones tube carriers (smaller lumens) exhibited significantly higher ECL (22.2% ± 7.1% and 24.0%-34.2% ± 5.0%, respectively).
- Graft thickness was found to be directly correlated with ECL (P < 0.01), especially in smaller lumen carriers.
Conclusions:
- Carrier size and shape significantly influence endothelial cell viability in DSAEK grafts.
- Smaller lumen carriers are associated with greater endothelial cell loss compared to larger carriers.
- In smaller carriers, increased DSAEK graft thickness exacerbates endothelial cell loss.
Purpose:
The aim of this study was to examine endothelial cell loss (ECL) associated with preloaded Descemet stripping automated endothelial keratoplasty (DSAEK) grafts loaded into 3 carriers of different size and shape.
Methods:
Thirty-six donor corneas were prepared for DSAEK and loaded into an EndoGlide Ultrathin (control) (2.0 mm × 3.5 mm lumen, 4.5 mm/4.9 mm incision for scleral tunnel/clear corneal insertion), Descemet membrane endothelial keratoplasty EndoGlide (experimental) (1.1 mm × 1.7 mm lumen, 2.65 mm incision), or round glass Jones tube (experimental) (1.8 mm lumen, 3.0 mm incision). Control grafts were stored for 6 days in Optisol-GS and experimental grafts stored for 24 hours in Life4C before analysis using Calcein AM staining. Grafts were imaged and ECL was analyzed by FIJI segmentation. The statistical significance of ECL was determined using 1-way ANOVA and Tukey post hoc analysis.
Results:
There were no significant differences in donor characteristics for grafts in each cohort. ECL for grafts loaded into the EndoGlide Ultrathin was 10.3% ± 2.3% (graft thickness: 60-189 μm, n = 9). ECL for grafts loaded into the Descemet membrane endothelial keratoplasty EndoGlide was 22.2% ± 7.1% (graft thickness: 38-63 μm, n = 9). ECL for thin grafts (34-60 μm, n = 9) loaded into the Jones tube was 24.0% ± 5.0%. ECL for thick grafts (92-119 μm, n = 9) loaded into the Jones tube was 34.2% ± 6.1% ECL ( P < 0.001). Combined regression analysis revealed that graft thickness is directly correlated to ECL ( P < 0.01).
Conclusions:
The size and shape of the carrier can influence the cell viability of preloaded DSAEK grafts. Compared with a larger carrier, smaller lumen carriers are associated with greater ECL. In smaller lumen carriers, ECL increases with increasing DSAEK graft thickness.
