Quantifying Corneal Endothelial Cell Damage During Descemet Membrane Endothelial Keratoplasty Graft Loading and...

Area of Science:

• Ophthalmology
• Corneal Surgery
• Endothelial Keratoplasty

Background:

• Descemet membrane endothelial keratoplasty (DMEK) is a surgical procedure to restore vision.
• Minimizing endothelial cell damage during graft preparation and transplantation is crucial for successful outcomes.
• Current techniques involve loading and ejecting grafts through specialized cannulas.

Purpose of the Study:

• To compare endothelial cell damage during loading and ejection of DMEK grafts using Straiko and Lions World Vision Institute (LWVI) glass cannulas.
• To quantify endothelial cell damage specifically from loading versus ejection in Straiko tubes.

Main Methods:

• DMEK grafts were stained with Calcein-AM (CAM) and imaged to assess baseline endothelial damage.
• Grafts were loaded and ejected using Straiko and LWVI cannulas, with subsequent imaging to measure changes in Area of Cell Damage (ACD).
• Custom Straiko 'half-tubes' isolated damage from loading versus ejection phases.

Main Results:

• Both Straiko and LWVI cannulas showed significant increases in ACD after loading and ejection, with no statistically significant difference between them (P = 0.42).
• In Straiko half-tubes, ejection alone caused significantly more endothelial cell damage (3.08% ± 0.31%) than loading alone (1.38% ± 0.36%) (P = 0.004).

Conclusions:

• Ejection, rather than loading, is the primary contributor to endothelial cell damage in DMEK grafts using Straiko tubes.
• The overall endothelial cell damage associated with loading and ejection was comparable between Straiko and LWVI cannulas.
• Endothelial cell damage quantification using CAM suggests lower overall damage compared to previous studies using different methodologies.