A Comparative Three-Center Study On Dsaek Grafts Preservation In The Corneal Hypothermic Storage Medium Xtra4
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR302 | Type: Free paper | DOI: 10.82333/289k-qb80
Authors: Dr Elena Tronchin* 1 , Mr Alessandro Ruzza 2 , Dr Moreno Piaia 1 , Dr Umberto Rodella 3 , Dr Nicholas Hicks 4 , Dr Jessica Ludwig 5 , Dr Laura Giurgola 3 , Dr Claudio Gatto 3 , Dr Onkar Sawant 6 , Dr Benjamin Julen 7 , Dr Stefano Ferrari 2 , Dr Jana D'Amato Tothova 3
1Research Unit,Fondazione Banca degli Occhi del Veneto ETS,Venezia,Italy;University of Ferrara,Ferrara,Italy, 2Research Unit,Fondazione Banca degli Occhi del Veneto ETS,Venezia,Italy, 3Research and Development,AL.CHI.MI.A. S.R.L, Moria Group,Ponte San Nicolò,Italy, 4Department of Clinical Operations,Eversight,Ann Arbor, MI,United States, 5Center for Vision and Eye Banking Research,Eversight,Cleveland, OH,United States, 6Department of Clinical Operations,Eversight,Ann Arbor, MI,United States;Center for Vision and Eye Banking Research,Eversight,Cleveland, OH,United States, 7Clinical Service,Miracles In Sight,Clemmons, NC,United States
Purpose
To evaluate human DSAEK grafts during preservation in the recently FDA-cleared corneal hypothermic storage medium XTRA4 (AL.CHI.MI.A. SRL, Moria Group) at 2-8°C, in comparison to the control media Eusol-C and Optisol-GS.
Setting
A total of fifty-seven (n=57) human corneas unsuitable for transplantation were recovered from three different eye banks (EBs) and included in this study. The corneas were stored in XTRA4 (n=45), Eusol-C (n=5), or Optisol-GS (n=7) at 2–8°C for 3–10 days. DSAEK grafts were prepared following the internal procedures of the EBs.
Methods
Grafts were evaluated immediately after the cut and during lamellar storage at 2–8°C for up to 72–96 hours in two EBs and for up to 5 days in the third EB (n=5 corneas in XTRA4 and n=2 corneas in Optisol-GS).
Endothelial Cell (EC) Density (ECD) was monitored with light or specular microscopies. EC mortality and morphology score were determined after Trypan Blue staining. Graft EC viability was assessed with Calcein-AM fluorescent dye. Morphological parameters CV% and HEX% were evaluated with specular microscopy. Optical coherence tomography (OCT) was employed to measure graft thickness (GT) immediately after the cut and during storage. The transparency of grafts stored in XTRA4 (n=35) and Eusol-C (n=5) was evaluated using a lux meter.
Results
All DSAEK grafts were successfully obtained after storage in all media. Graft ECD was comparable among the groups both immediately after DSAEK graft preparation and during storage with no significant differences in CV%, HEX%, EC morphology score, EC mortality, and EC viability, both after the cut and after graft storage. No significant differences were observed in GT after the cut. XTRA4 maintained GT unchanged up to 5 days at 2–8°C, while the Eusol-C and Optisol-GS stored grafts showed a significant increase in thickness of +57±75 µm and +56±48 µm at 3 days of graft storage, respectively. Transparency was significantly higher in XTRA4-stored grafts (66.6±6.0%) compared to Eusol-C stored grafts (55.7±6.1%) after 72–96 hours of storage.
Conclusions
DSAEK grafts were successfully obtained from human corneas stored in XTRA4 medium at 2–8°C for 3–10 days. The grafts preserved in XTRA4 medium at 2–8°C showed comparable results in terms of ECD, EC morphology, and EC viability to those preserved in control media for up to 5 days. However, XTRA4 better maintained DSAEK graft thickness and transparency during storage at 2–8°C. These results provide new perspectives for achieving stable graft thickness during the transport of DSAEK grafts to operating theatres under hypothermic conditions.