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Descemet's membrane endothelial keratoplasty: a comparison of endothelial cell survival between a novel tri-fold (endothelial-in), pull through technique and a scroll (endothelial-out) injection technique

Poster Details

First Author: E.Chan AUSTRALIA

Co Author(s):    P. Finn   E. Chong                 

Abstract Details


Current techniques for donor insertion during Descemet Membrane Endothelial Keratoplasty (DMEK) involve the injection of a scroll, where the endothelial cells are oriented on the outside. However, this endothelial-out orientation may lead to cell damage. In this study, we compare endothelial cell survival using a novel, endothelial-in, pull through technique and compare it to an established scroll injection technique.


This study was performed at the Lions Eye Donation Service, University of Melbourne, Centre for Eye Research Australia and Royal Victorian Eye and Ear Hospital, Melbourne, Australia.


10 cadaveric corneas with endothelial cell densities (ECD) above 2000/mm2 were used. An 8.0mm Descemet membrane (DM) graft was prepared using a standardised technique in each case. The DM was then injected onto a glass slide using: A) an endothelial-in, tri-fold, pull-through technique using the Tan Endoglide; B) an endothelial-out, DM scroll which was injected through the Geuder (Geuder AG, Heidelberg) glass pipette. ECD before and after insertion of the tissue was assessed by microscopy. Vital stains with calcein AM and DAPI were also performed to assess cell survival across the entire 8.0mm DM graft.


Compared to the pre-insertion ECD, the post-insertion ECD remained the same in technique A (pre-insertion 2296 �Â�± 338.3, post-insertion 2331 �Â�± 495.3), whereas a small, but not statistically significant decrease in the central ECD (pre-insertion 2548.3 �Â�± 408.5, post-insertion 2427.7 �Â�± 288.7) was noted following insertion using technique B. However, vital stain mapping showed significant differences in patterns of cell survival, with larger areas of calcein AM staining, indicating surviving cells, following technique A.


There were more areas of viable endothelial cells on the DM using Technique A compared to B. Further validation and development of this technique is worthwhile.

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