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Aspiration of tri-folded, endothelium-in grafts for Descemet Membrane Endothelial Keratoplasty

Authors
  • Karakus, Sezen1
  • Ighani, Mehrnaz1
  • Noparat, Pete1
  • Tofigh, Marjan1
  • Chiang, Eric2
  • Barnes, Kali2
  • Chen, Conan Y.3
  • Liu, Tiffany S.1
  • Eghrari, Allen O.1
  • 1 Wilmer Eye Institute at Johns Hopkins, Baltimore, Maryland
  • 2 Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
  • 3 University of Colorado School of Medicine, Aurora, Colorado
Type
Published Article
Journal
Cornea
Publication Date
May 01, 2019
Volume
38
Issue
5
Pages
654–657
Identifiers
DOI: 10.1097/ICO.0000000000001888
PMID: 30702471
PMCID: PMC6443421
Source
PubMed Central
Keywords
License
Unknown

Abstract

Purpose: In Descemet Membrane Endothelial Keratoplasty (DMEK), loading and positioning of tri-folded grafts into a cartridge is generally conducted with forceps or a hook, risking graft tear or trauma. We demonstrate the feasibility of loading tri-folded grafts into a cartridge with no touch to the endothelium required beyond the tri-folding process. Methods: A corneoscleral rim with a pre-stripped DMEK graft is placed into a petri dish. After the graft is tri-folded with forceps and removed from its stromal attachment, the graft is gently wicked into the tip of a saline-filled Alcon B IOL cartridge connected to IV extension tubing and a 3cc syringe, drawn into the cartridge by positioning it adjacent to the graft tip. The remainder of the graft is aspirated with the addition of saline. The cartridge orientation is reversed for graft injection. In this retrospective analysis, we analyzed surgical video for preparation times, and assessed postoperative visual acuity, pachymetry, and endothelial cell density. Results: Thirteen cases underwent this approach. Median preparation time from stain to cartridge eye contact was 8.5 minutes, and time from graft injection to final centration and bubbling was 2.9 minutes. Corneal thickness decreased from a median of 623 microns preoperatively to 566 microns at one month (p=0.038). Visual acuity improved by one month by a median of 0.3 logMAR (p=0.016). Endothelial cell density decreased by 32.4% at one month compared to baseline. Conclusion: Endothelium-in DMEK grafts may be loaded into a plastic cartridge using a skill set similar to aspiration of a scroll.

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