Pre-prepared Corneal Grafts for Facilitated Descemet Membrane Endothelial Keratoplasty (DMEK) — Controlled and Standardized Manufacturing in the Eye Bank May Lead to Reduced re-DMEK Rates

Authors

Nicola Hofmann, Ilka Wittmershaus, Regina Michaelis, Tanja Petrich, Lutz Blomberg, Martin Börgel

Abstract

Purpose: Descemet membrane endothelial keratoplasty
(DMEK) has become the gold standard for partial thickness corneal
transplant surgeries. In the past most lamella were prepared
by the surgeon directly before the operation in the operating
room (OR). Since 2015, a preparation procedure in a DGFG1 eye
and tissue bank was established to supply transplant surgeons
with pre-cut cornea grafts. However, the question arises whether
this could have an influence on the clinical outcome of DMEK.

Method: Using our preparation procedure, pre-cut donor corneas
are produced with a success rate of ≥ 90%. A comparison of
the numbers of patients requiring regrafts according to DMEK/
LaMEK was carried out to provide information about the success
of the procedure when using pre-cut lamellae.

Results: Since December 2015, the DGFG holds a Paul-Ehrlich-
Institute (PEI)2 marketing authorization and has delivered
more than 600 pre-cut donor corneas for DMEK procedures.
marketed by DGFG as LaMEK. Compared to 2015 with grafts
prepared exclusively in the operating room, in 2016/2017, with
the prepared LaMEK grafts, a smaller number of regrafts were
reported in four transplantation centers. In 2015, 22 out of 204
OR-prepared lamellae DMEKs had to be regrafted (MW 10.8%
regraft rate). During the reference period 2016 to autumn 2017
in the same transplant centers, only six out of 147 LaMEK prepared
corneas (MW 4.1%) were regrafted.

Conclusions: With the introduction of pre-cut donor corneas
(LaMEK) for DMEK procedures, the technique for the surgeon
has been significantly simplified, since a preparation risk is excluded
and time and costs in the OR are reduced. In addition, use
of LaMEK seems to reduce the risk of regraft for the patient.