ESCRS - POCOR284 - Preservation Of Stromal Corneal Tissue After Descemet Membrane Removal Using A Novel Hypothermic Storage Medium (Xtra4): A Porcine Preclinical Study

Preservation Of Stromal Corneal Tissue After Descemet Membrane Removal Using A Novel Hypothermic Storage Medium (Xtra4): A Porcine Preclinical Study

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR284 | Type: Poster | DOI: 10.82333/t9ng-z120

Authors: Dr Valentin Jünger* 1 , Dr Andrea Margarella 2 , A/Prof. Carlo Nucci 3 , Dr Rossella Anna Maria Gisoldi Colabelli 4 , A/Prof. Augusto Pocobelli 4

1Department of Ophthalmology and Experimental Medicine,University of Rome Tor Vergata,Rome,Italy;Department of Ophthalmology,Rome Eye Bank, San Giovanni Addolorata Hospital,Rome ,Italy, 2Department of Clinical Medicine, Public health, Life and Environmental Sciences,University of L’Aquila,L’Aquila,Italy;Department of Ophthalmology,Rome Eye Bank, San Giovanni Addolorata Hospital,Rome,Italy, 3Department of Ophthalmology and Experimental Medicine,University of Rome Tor Vergata,Rome,Italy, 4Department of Ophthalmology,Rome Eye Bank, San Giovanni Addolorata Hospital,Rome,Italy

Purpose

Global demand for donor corneal tissue continues to exceed supply, requiring eye banking strategies that maximize tissue utilization. Split-cornea allocation, enabling endothelial keratoplasty (EK) and anterior lamellar keratoplasty (ALK) from a single donor cornea, represents one such strategy. Extended preservation of anterior stromal grafts following endothelial graft preparation could facilitate delayed allocation for ALK procedures. This study evaluated the ability of a novel hypothermic storage medium, XTRA4 (AL.CHI.MI.A. SRL, Moria Group), to preserve anterior stromal corneal grafts after Descemet membrane removal.

Setting

Preclinical laboratory study using porcine anterior stromal grafts resulting form Descemet membrane removal by preparation of Descemet Stripping Endothelial Keratoplasty (DSAEK) grafts.

Methods

Preparation of DSAEK grafts was achieved by mounting porcine corneas in an ALTK artificial anterior chamber with an ACP pressurizing system set at 200 mmHg (Moria SA, France) and cutting with a CBm turbine. The resulting anterior stromal grafts were stored in XTRA4 (n=4) or Corneal Chamber (n=4) at 2–8 °C (AL.CHI.MI.A. SRL, Italy). Graft thickness (GT) was measured with a digital thickness gauge (Mitutoyo, Japan) immediately after preparation (day 0) and during storage (days 1, 4, and 7).

Results

Baseline graft thickness was comparable between groups (XTRA4: 450±22 µm; Corneal Chamber: 438±22 µm; p>0,05). Grafts stored in XTRA4 showed an initial decrease in thickness after 24 hours (353±29 µm) and remained stable through day 7 (328±22 µm). In contrast, Corneal Chamber grafts showed progressive edema, increasing from day 1 (593±33 µm) to day 7 (723±33 µm). Relative to baseline, graft thickness at day 7 decreased by -27.1% in the XTRA4 group, whereas grafts stored in Corneal Chamber increased by +65.1% (p < 0.001).

Conclusions

After Descemet membrane removal XTRA4 maintained stromal graft thickness stability during hypothermic storage, whereas Corneal Chamber resulted in progressive tissue edema and loss of suitability for ALK procedures. Extended preservation of stromal tissue following endothelial graft preparation may provide additional logistical flexibility for eye banks and support split-cornea allocation strategies aimed at improving overall donor tissue utilization.