Cornea Transplant Teaching Techniques: One Cornea Donor Tissue For Two Purposes

There is a national shortage in the UK in corneal graft material. The majority (69%) of corneal transplants in the UK are partial thickness, with 35% being Descemet membrane endothelial keratoplasty (DMEK)_.  Following preparation of the donor tissue in DMEK surgery, the remainder of the donor tissue (epithelium, Bowman’s and stroma) is discarded . It is thought that a single donor cornea can be used for two patients by combining DMEK and deep anterior lamellar keratoplasty (DALK) procedures on the same list. However, this is not routinely performed in the UK.  A further impact of reduced tissue availability is the effect on training of future corneal surgeons. Therefore using the discarded tissue provides unique teaching opportunities. 

We present a teaching technique, whereby the remainder of the corneal donor tissue not used for the DMEK surgery can be used for training purposes, without the use of any additional resources. 

Following the preparation of the donor tissue for DMEK surgery, rather than discarding the remainder of the donor tissue, this tissue can be effectively used for providing training in theatre at the end of the list under consultant supervision. The instruments from the case are kept aside and are used for the training to avoid having to use any additional kit.  

Trainees can enhance their corneal surgical skills in graft preparation and suturing on this remaining donor tissue. The skills include attaching the corneal button to the suction device; practicing raising the edge of Descemet membrane to ensure the correct plane is achieved; peeling the remaining Descemet membrane; practice loading tissue into the loading device and injecting it. The donor tissue can be used for simulated penetrating lacerations to teach cornea suturing techniques. Cornea suturing and repair of penetrating injury are an invaluable skill that many trainees may not have sufficient exposure to. Furthermore, as this uses actual human donor cornea material, the experience of tissue handling is as close to reality. 

Given the national shortage of donor cornea graft material and the impact this has on training, the teaching technique presented may provide trainees nationally an opportunity to develop cornea suturing and transplant skills, using tissue that would otherwise be discarded. This helps provide an invaluable training opportunity to aspiring cornea surgeons without using any additional resources or material.