Performance outcomes from a DMEK peeling and preparation wet lab

Area of Science:

• Ophthalmology
• Surgical Training
• Corneal Transplantation

Background:

• Descemet membrane endothelial keratoplasty (DMEK) is a specialized endothelial keratoplasty technique.
• Effective graft preparation is crucial for DMEK success.
• Trainee surgeons require supervised training to master DMEK procedures.

Purpose of the Study:

• To assess the learning curve and performance of trainee surgeons in preparing DMEK grafts.
• To evaluate the efficacy of ex vivo wet lab simulations for DMEK training.
• To quantify improvements in graft preparation metrics during simulated DMEK procedures.

Main Methods:

• Utilized human donor corneoscleral rims unsuitable for transplantation.
• Trainee surgeons performed simulated DMEK graft preparations in a wet lab setting.
• Assessed graft preparation by measuring procedural time, trypan blue positive cells (TBPC), cell density, tear occurrence, and peel-off completeness.

Main Results:

• Significant reductions in procedural time (17.6 to 10.6 min) and TBPC percentage (12.9% to 3.8%) were observed between the first and last attempts.
• A trend towards reduced peripheral and central tears was noted.
• Longer peeling times correlated significantly with higher TBPC (p<0.001), indicating increased endothelial cell loss.

Conclusions:

• Ex vivo DMEK wet labs offer a valuable, risk-free environment for surgical trainees.
• This simulation setting demonstrably improves DMEK graft preparation skills and confidence.
• Wet lab training is essential for flattening the learning curve and promoting wider adoption of DMEK surgery.