Perioperative Evaluation Of Endothelial Cell Viability Before Corneal Transplant Surgery: Image Analysis For A Final Assessment In The Operating Room
Published 2023 - 41st Congress of the ESCRS
Reference: PP17.08 | Type: Free paper | DOI: 10.82333/hz97-pz87
Authors: Matteo Airaldi* 1 , Maria Laura Passaro 2 , Chiara Ancona 3 , Eliana Forbice 4 , Antonio Iaria 4 , Francesco Semeraro 3 , Stephen B Kaye 5 , Vito Romano 6
1Department of Molecular and Translational Medicine,University of Brescia,Brescia,Italy;Department of Biomedical and Clinical Science "Luigi Sacco",University of Milan,Milan,Italy, 2Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health,University of Brescia,Brescia,Italy;Department of Neurosciences, Reproductive Sciences and Dentistry,University of Naples "Federico II",Naples,Italy, 3Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health,University of Brescia,Brescia,Italy, 4U.O.C. Oculistica,ASST Spedali Civili di Brescia,Brescia,Italy, 5Eye and Vision Science, Institute of Life Course and Medical Sciences,University of Liverpool,Liverpool,United Kingdom;Department of Corneal Diseases, St. Paul's Eye Unit,Royal Liverpool University Hospital,Liverpool,United Kingdom, 6Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health,University of Brescia,Brescia,Italy;Eye and Vision Science, Institute of Life Course and Medical Sciences,University of Liverpool,Liverpool,United Kingdom;Department of Corneal Diseases, St. Paul's Eye Unit,Royal Liverpool University Hospital,Liverpool,United Kingdom
Purpose
To describe a novel, accessible, and simple method to perioperatively evaluate the viability of the donor corneal endothelium in the operating theatre
Setting
Cross-sectional, multicentric study
Methods
Corneal tissues for transplantation were assessed for endothelial viability before implantation with the following method: the endothelium was stained for 30 seconds with 0.05% Trypan Blue, then the dye was gently washed away with balanced salt solution. The corneal tissue was placed face-up on the trephine base, then pictures were taken and exported to ImageJ in the operating room. A custom macro was written to automatically enhance image contrast throughCLAHE, then auto-threshold the image with the Percentile algorithm, and finally calculate the percentage of Trypan Blue-positive areas (TBPA) on 4 selected Regions Of Interest, which were drawn in the 4 corresponding quadrants taking care to avoid the markings of the trephine base.
Results
A total of 16 images from 16 corneal transplants (2 PKs, 3 DALKs, 4 DSAEKs, 7 DMEKs) were included. The mean (standard deviation) percentage of TBPA of the corneal tissues was 23.2% (11.4%). The median (interquartile range) Endothelial Cell Density (ECD) provided by the eye bank on the tissue sheet was 2600 (2550, 2750) cells/mm2. There was a positive correlation between the percentage of TBPA and ECD (ρ = 0.6), although this correlation was not statistically significant (p = .053). In two cases, both scheduled for DMEK surgery, the surgeon decided not to proceed with implantation due to the high proportion of TBPA (mean [standard deviation] TBPA 44.2% [4.5%] and 39.6% [12.8%]).
Conclusions
The described method provides the corneal surgeon with a tool to perioperatively assess the viability of the donor corneal endothelium before implantation, allowing for a final check of the suitability of the tissue. In this cases series, two donor corneal tissues were rejected as they were deemed unsuitable for implantation by the surgeon due to their large TBPA, indicating a high endothelial cell mortality.