Table of Contents
Tissue Processing for Ultra-Thin Descemet Stripping Automated Endothelial Keratoplasty
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.
Melles GR, Eggink FA, Lander F, et al. A surgical technique for posterior lamellar keratoplasty. Cornea.1998;17(6):618-626. PMID:9820943.
Gorovoy MS. Descemet-stripping automated endothelial keratoplasty. Cornea. 2006;25(8):886-889. PMID:17102661.
Price MO, Price FW Jr. Endothelial keratoplasty – a review. Clin Experiment Ophthalmol. 2010;38(2):128-140. doi:10.1111/j.1442-9071.2010.02213.x.
EBAA. Eye Bank Association of America 2012 Eye Banking Statistical Report. Washington, DC: EBAA;2013. http://www.restoresight.org/wp-content/uploads/2013/04/2012_Statistical_Report_FINALreduced-size-4-10.pdf. Accessed March 9, 2014.
Bahar I, Kaiserman I, McAllum P, et al. Comparison of posterior lamellar keratoplasty techniques to penetrating keratoplasty. Ophthalmology. 2008;115(9):1525-1533. doi:10.1016/j.ophtha.2008.02.010.
Soong HK, Katz DG, Farjo AA, et al. Central lamellar keratoplasty for optical intractions. Cornea. 1999;18(3):249-256. PMID: 10336023.
Terry MA, Straiko MD, Goshe JM, et al. Descemet’s stripping automated endothelial keratoplasty: the tenuous relationship between donor thickness and postoperative vision. Ophthalmology. 2012;119(10):1988-1996. doi:10.1016/j.ophtha.2012.05.021.
Price MO, Price FW Jr. Descemet’s stripping with endothelial keratoplasty: comparative outcomes with microkeratome-dissected and manually dissected donor tissue. Ophthalmology. 2006;113(11):1936-1942. PMID: 16935344.
Terry MA, Shamie N, Chen ES, et al. Precut tissue for Descemet’s stripping automated endothelial keratoplasty: vision, astigmatism, and endothelial survival. Ophthalmology. 2009;116(2):248-256. doi:10.1016/j.ophtha.2008.09.017.
Nieuwendaal CP, van Velthoven ME, Biallosterski C, et al. Thickness measurements of donor posterior disks after descemet stripping endothelial keratoplasty with anterior segment optical coherence tomography. Cornea. 2009;28(3):298-303. doi:10.1097/
Neff KD, Biber JM, Holland EJ. Comparison of central cornal graft thickness to visual acuity outcomes in endothelial keratoplasty. Cornea. 2011;30(4):388-91. doi:10.1097/ICO.0b013e3181f236c6.
Price FW Jr, Busin M. Ultra-thin grafts: the next advance in corneal lamellar surgery. Ophthalmol Manag. May 1, 2011. http://www.ophthalmologymanagement. com/articleviewer.aspx?articleid=105623. Accessed March 9, 2014.
Anshu A, Price MO, Price FW Jr. Risk of corneal transplant rejections significantly reduced with Descemets membrane endothelial keratoplasty. Ophthalmology. 2012;119(3):536-40. doi:10.1016/j.ophtha.2011.09.019.
Parker J, Dirisamer M, Naveiras M, et al. Outcomes of Descemet membrane endothelial keratoplasty in phakic eyes. J Cataract Refract Surg. 2012; 38(5):871-7. doi:10.1016/j.jcrs.2011.11.038.
Michigan Eye-Bank. Eye Donor Criteria. Ann Arbor, MI: Michigan Eye-Bank; 2010. http://www.michiganeyebank. org/communities/healthcare-professionals/eye-donor-criteria.htm. Accessed March 4, 2014.
Price FW Jr, Price MO. Descemet’s stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant. J Refract Surg. 2005;21(4):339-345. PMID:16128330.
Rose L, Briceño CA, Stark WJ, et al. Assessment of eye bank-prepared posterior lamellarcorneal tissue for endothelial keratoplasty. Ophthalmology. 2008;115(2):279-286. PMID:17599413.
Midwest Eye-Banks. Reference Document E1.710. Corneal Tissue Preparation for Lamellar Procedures. 1-5. Ann Arbor, MI: Midwest Eye-Banks; 2010.
Price MO, Baig KM, Brubaker JW, et al. Randomized, prospective comparison of precut vs surgeon-dissected grafts for descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2008;146(1):36-41. doi:10.1016/j.ajo.2008.02.024.
Sikder S, Nordgren RN, Neravetla SR, et al. Ultra-thin donor tissue preparation for endothelial keratoplasty with a double-pass microkeratome. Am J Ophthalmol. 2011;152(2);202-208.e2. doi:10.1016/j.ajo.2011.01.051.