Abstract
PurposeTo optimize methods of preparing donor cornea tissue for Descemet's stripping automated endothelial keratoplasty (DSAEK), we compared five experimental conditions with different internal pressures and cutting systems.MethodsThe artificial anterior chamber internal pressure (IP) was set at 100 or 200 mm Hg. The microkeratome cut was performed with or without an artificial chamber pressurizer (ACP), using a CBm turbine (CBm) or one use-plus automated (OUP-A). Thirty human research corneas were divided into five groups, and compared after the cut with donor tissue quality parameters, including cutting depth, graft uniformity, cell evaluation, and smoothness of the stromal surface.ResultsThe smallest variation in mean cut depth was observed in the condition, which had IP of 200 mm Hg used ACP and OUP-A. In experimental groups cut using CBm, significantly more consistent thicknesses were made at an IP of 200 than 100 mm Hg. There were no statistically significant differences among the groups in either endothelial cell density or cell viable assay results after cuts. Using an IP of 200 mm Hg with ACP and CBm produced the roughest stromal surface, and the roughness grading scores showed a positive correlation with the percentage of cut depth.ConclusionsAn IP of 200 mm Hg was the best setting for DSAEK grafts with high predictability of cut depth and uniformity of graft thickness without endothelial cell damage.Translational RelevanceFor successful DSAEK, it is recommended that a set internal pressure of 200 mm Hg be used during microkeratome cutting for donor tissue preparation.
Highlights
Descemet’s stripping automated endothelial keratoplasty (DSAEK) is currently the most widely used procedure for treating corneal endothelial dysfunction, such as Fuchs’ endothelial dystrophy and pseudophakic bullous keratopathy.[1]
Translational Relevance: For successful DSAEK, it is recommended that a set internal pressure of 200 mm Hg be used during microkeratome cutting for donor tissue preparation
Even if the same-sized head is used for all cutting, it produces a wide range of final tissue thicknesses, because the relationship between microkeratome head size and final tissue thickness is imprecise.[11,12]
Summary
Descemet’s stripping automated endothelial keratoplasty (DSAEK) is currently the most widely used procedure for treating corneal endothelial dysfunction, such as Fuchs’ endothelial dystrophy and pseudophakic bullous keratopathy.[1]. Even if the same-sized head is used for all cutting, it produces a wide range of final tissue thicknesses, because the relationship between microkeratome head size and final tissue thickness is imprecise.[11,12] some studies have shown that DSAEK grafts prepared using a microkeratome produce nonuniform thickness profiles and variable central graft thickness.[8,11,12,13,14] Previous studies have evaluated the quality of DSAEK lenticles using various methods, including endothelial cell counting,[15] thickness measurements,[16,17] and smoothness of surface measurements.[18,19] it is essential to TVST j 2018 j Vol 7 j No 6 j Article 11
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