A Comparative Assessment Of Safety And Performance Of Two Microkeratome Systems During Pressure-Controlled Dsaek Graft Preparation
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR303 | Type: Free paper | DOI: 10.82333/dzsm-5s83
Authors: Dr Elena Tronchin* 1 , Mr Alessandro Ruzza 2 , Dr Moreno Piaia 1 , Dr Umberto Rodella 3 , Dr Claudio Gatto 3 , Dr Cyril Prudhomme 4 , 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. SRL, Moria Group,Ponte San Nicolò,Italy, 4Research and Development,Moria Group,Massy,France
Purpose
A safe and reliable microkeratome system is essential for Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) graft preparation to achieve a consistently thin lamellar dissection while preserving endothelial quality. Both the CBm turbine and the newer One Use-Plus (OUP) microkeratomes (Moria SA, France) are commonly employed routinely to prepare ultra-thin (UT) DSAEK grafts, with graft thicknesses (GT) of less than 80 µm, in eye banks.
This study aimed to evaluate the effect of these two microkeratome systems on the quality of corneal tissue prepared for DSAEK grafts.
Setting
This study was performed on twelve (n=12) donor corneas unsuitable for transplantation after deswelling phase in CARRY-C (AL.CHI.MI.A. S.R.L., Moria Group, Italy) for up to 48h at room temperature. Each pair of corneas were assigned randomly into two experimental groups: in a first group DSAEK grafts were prepared with the CBm Turbine microkeratome, while in a second group grafts were prepared with the OUP microkeratome.
Methods
Grafts in both groups were prepared using the Evolution 3E console with ALTK artificial anterior chamber (AAC, Moria SA, France) and TISSUE-C (AL.CHI.MI.A. S.R.L., Moria Group, Italy) as AAC-filling medium and the ACP pressurizing system (Moria SA, France) to maintain standard 200 mmHg pressure. Cutting head selection was guided by the OUP nomogram, based on minimal corneal thickness (MCT).
Pre- and post-cut corneal quality was assessed by light microscopy analyzing endothelial cell (EC) density (ECD), EC morphology, and EC mortality after Trypan Blue staining. EC mortality was further quantified via fluorescent microscopy after Calcein-AM staining, analyzed with FIJI software. GT was verified with optical coherence tomography (OCT).
Results
In both groups, ECD levels remained stable following the cut, with no significant inter-group differences noted.
Using microkeratomes with ACP pressure and TISSUE-C as AAC-filling medium preserved EC viability during graft preparation, and no notable differences were found between groups based on both light and fluorescent microscopy examinations.
After lamellar cut, EC morphology was well maintained and statistically comparable among groups.
OUP showed a lower mean GT compared to CBm, despite this difference was not statistically significant.
Conclusions
This study showed that both OUP and CBm microkeratomes, using ACP pressure control at 200 mmHg and TISSUE-C as AAC-filling medium, maintained optimal endothelial viability, cell density, and morphology, thus maximizing graft quality preservation for DSAEK surgery.
Moreover, under standardized conditions, with identical intracameral pressure and microkeratome cutting heads of the same nominal cutting depth, the OUP system produced thinner grafts than the CBm, though the difference was not significant, possibly due to this study's limited sample size.
In conclusion, both the microkeratome systems proved effective and safe for preparing DSAEK grafts and maximize quality of tissue to be transplanted.