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Early clinical outcomes of pre-loaded Descemet's membrane endothelial keratoplasty grafts with endothelium tri-folded inwards

Poster Details

First Author: C.Bovone ITALY

Co Author(s):    P. Leon   A. Ruzza   S. Ferrari   D. Ponzin   M. Parekh   M.      

Abstract Details


To evaluate the initial outcomes and complications of Descemet membrane endothelial keratoplasty (DMEK) utilizing donor tissues tri-folded with the endothelium inwards, pre-loaded at the Eye Bank and delivered with bimanual pull-through technique.


Tertiary care, multi-practice centre, "Villa Igea" private hospital Forlì, Italy


25 eyes of patients with Fuchs endothelial dystrophy with or without cataract operated between November 2016 and March 2017 were evaluated. DMEK tissues prepared with SCUBA technique and punched to a diameter of 8.25mm were pre-loaded with the endothelium tri-folded inwards in an intraocular lens (IOL) cartridge with a 2.2mm opening filled with the same tissue culture medium contained in the vial used for shipment to the surgeon. Standardized DMEK was performed within 48 hours from preparation. Preparation and surgical times, intraoperative and postoperative complications, best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), and graft detachment rate were evaluated.


Preparation time averaged 27.9±4.4 minutes, while surgical time never exceeded 9 minutes. Surgery was uneventful in all cases. Postoperative complications included graft detachment in 5 cases (20%), successfully managed in all cases by single re-bubbling within 6 days from surgery, and glaucoma irresponsive to conservative treatment in 1 case (4%). In all eyes without co-morbidities (n = 22) BSCVA was 20/25 or better as early as 3 months after surgery. 6 months postoperatively, ECD was available in 16 eyes with an endothelial cell loss calculated as a percentage of the preoperative value determined at the eye bank of 31.59±11.73%.


Delivering a pre-loaded DMEK tissue, tri-folded with the endothelium inwards, minimizes surgical time and costs without negatively affecting the outcomes of the procedure.

Financial Disclosure:

travel has been funded, fully or partially, by a competing company

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