Thérèse M. Peron, Roni M. Schtein, MD, Michael S. Titus, CEBT, Maria A. Woodward, MD
corneal transplantation, Descemet stripping endothelial keratoplasty, eye banks
PURPOSE: To optimize tissue preparation for ultra-thin Descemet stripping automated endothelial keratoplasty (DSAEK) by evaluating outcomes of double-cut corneal tissue processing on an artificial anterior chamber.
METHODS: Thirty-two corneas were analyzed. Donor corneas underwent microkeratome (MK) double-cut tissue processing. The corneal tissue was first cut at the thickest peripheral point and then 180 degrees away from the first pass. The tissue was measured by ultrasound (US) and optical coherence tomography (AS-OCT) for corneal thickness analysis and by specular microscopy for endothelial cell density.
RESULTS: Utilizing a double-pass technique, investigators successfully processed 24 of 32 corneas for ultra-thin DSAEK. Eight corneas perforated during tissue processing. The perforated tissues had no difference in tissue thickness prior to MK cuts but had a statistically significant lower mean central (P=0.034) and thinnest peripheral thickness (P=0.019) between MK cuts compared to tissues that did not perforate. Perforated tissues were more asymmetric (P=0.0092). Of the successfully processed tissues, 70.8% of tissues achieved a thickness of ≤100 μm; however, 9 had significant endothelial cell damage that did not correlate with tissue thickness. Regarding tissue cutting, a strong correlation existed between the amount of tissue cut and MK head size used for the first pass (r=0.82) but not for the second pass (r=0.22).
CONCLUSIONS: The double-pass technique can create ultra-thin DSAEK tissue; however, certain tissue characteristics, processing techniques, and MK head size play a role in successful donor corneal tissue processing.
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Reviewer Acknowledgement 2012-2013
Looking Back on the First 18 Months of Publication and Looking Forward to Opportunities to Come
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