Cell Damage Of Donor Grafts For Ultrathin Descemet Stripping Automated Of Endothelial Keratoplasty (Ut-Dsaek) When Preloaded In The Two Commercial Carriers

Availability of preloaded tissue may increase acceptance of UT-DSAEK in the surgical management of the endothelial disease. The goal of this study was to determine the endothelial cell damage of the UT-DSAEK grafts when loaded into novel Weiss Glass Canula for DSAEK and EndoGlide UT DSAEK device

Study performed at the Lions Eye Institute for Transplant and Research, Tampa, Florida, United States

10 UT-DSAEK grafts (averaged 80 microns thickness) prepared with HPAC microkeratome method. Stained (0.06% Trypan blue), photographed using a back-light technique. 8 mm donor buttons were trephined. 5 grafts were loaded from the designated platform into EndoGlide DSAEK without prior graft folding and 5 grafts were manually tri-folded and loaded into Weiss Glass Cannula from a novel loading platform. OCT was used for inside injector graft evaluation. Each graft in EndoGlides was unloaded with 27G unloading forceps and grafts in Weiss Glass Cannula via fluid ejection. Then gently unfolded with the endothelial side up, re-stained, and photographed. Endothelial cell loss (ECL) analyzed via ImageJ software

OCT revealed a uniform round configuration in the Weiss Glass cannula for all 5 preloaded grafts and an ununiform and divided oval shape configuration in the EndoGlide DSAEK in all 5 grafts. Mean ECL for grafts loaded into Weiss Glass Canula was 5.5% and 13.5% for EndoGlide DSAEK respectively

Mean ECL was lower in the Weiss Glass Canula group. An uncontrolled force of graft folding during loading and uneven folded grafts orientation inside of device are likely contributing factors to higher ECL in the EndoGlide DSAEK group uneven