Endothelial keratoplasty with infant donor tissue

PurposeTo compare the incidence of fungal infection after endothelial keratoplasty (EK) when donor tissue had been stored in hypothermic medium or organ culture.MethodsWe describe the clinical features of 10 cases of fungal infection (keratitis or endophthalmitis) following EK identified at three European centres. Case definition was the culture of fungus or a positive PCR from the host cornea or anterior chamber after EK. A survey of the incidence of infection after EK was conducted by the European Eye Bank Association. The main outcome measure was the number of cases in which donor tissue had been stored in hypothermic medium compared with organ culture.ResultsThe 10 cases occurred between 2014 and 2017. All donor corneas had been stored in hypothermic medium sourced from three US eye banks. Three pairs of mate corneas caused infections in six recipients. Candida spp were identified from nine cases, with one isolate of Purpureocillium lilacinum. Data on 16 862 corneas supplied for EK were available from 16 European eye banks for the 5-year period from 2012. There were 17 reported cases of infection, of which 15 (88%) were fungal infections and 14 (82%) were Candida spp. Fungal infection was reported from 3 of 14 476 (0.02%) corneas supplied in organ culture compared with 12 of 2386 (0.50%) corneas supplied in hypothermic medium (p<0.0001). The incidence of infection after hypothermic storage was similar for material sourced from Europe (0.52%) or the USA (0.61%).ConclusionsInfection after EK is strongly associated with Candida spp. The possible explanations for the higher incidence of infection when tissue is stored in hypothermic medium are discussed.

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Endothelial Keratoplasty Using Donor Tissue Not Suitable for Full-Thickness Penetrating Keratoplasty

Cornea ◽

10.1097/ico.0b013e3180335511 ◽

2007 ◽

Vol 26 (5) ◽

pp. 515-519 ◽

Cited By ~ 22

Author(s):

Rebecca L Armour ◽

Paula J Ousley ◽

Jennifer Wall ◽

Karen Hoar ◽

Chris Stoeger ◽

...

Keyword(s):

Penetrating Keratoplasty ◽

Endothelial Keratoplasty ◽

Full Thickness ◽

Donor Tissue

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Donor tissue detachment after descemet stripping automated endothelial keratoplasty (DSAEK): a 35 mhz probe ubm study

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2008.551.x ◽

2008 ◽

Vol 86 ◽

pp. 0-0

Author(s):

A SAVASTANO ◽

S SBORDONE ◽

P VALERIO ◽

R FORTE ◽

L TAMBURRINI ◽

...

Keyword(s):

Endothelial Keratoplasty ◽

Donor Tissue

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Preloaded Descemet Membrane Endothelial Keratoplasty Donor Tissue

Cornea ◽

10.1097/ico.0000000000001787 ◽

2019 ◽

Vol 38 (1) ◽

pp. e1

Author(s):

Pranita Sahay ◽

Deepali Singhal ◽

Prafulla K. Maharana ◽

Jeewan S. Titiyal

Keyword(s):

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Donor Tissue ◽

Descemet Membrane

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Eye Bank Survey of Surgeons Using Precut Donor Tissue for Descemet Stripping Automated Endothelial Keratoplasty

Cornea ◽

10.1097/01.ico.0000611368.89170.56 ◽

2008 ◽

Vol 27 (6) ◽

pp. 634-639 ◽

Cited By ~ 1

Author(s):

Anna S Kitzmann ◽

Kenneth M Goins ◽

Cynthia Reed ◽

Lissa Padnick-Silver ◽

Marian S Macsai ◽

...

Keyword(s):

Endothelial Keratoplasty ◽

Eye Bank ◽

Donor Tissue

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Pseudophakic corneal donor tissue in Descemet membrane endothelial keratoplasty (DMEK): implications for cornea banks and surgeons

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2020-000524 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000524

Author(s):

Daniel Pilger ◽

Necip Torun ◽

Anna-Karina B Maier ◽

Jan Schroeter

Keyword(s):

Endothelial Cell ◽

Functional Results ◽

Cell Loss ◽

Tissue Preparation ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Donor Tissue ◽

Descemet Membrane ◽

The Difference ◽

Corneal Donor Tissue

ObjectiveIncreasingly, cornea banks are recovering donor tissue from pseudophakic donors. Little is known about their suitability for Descemet membrane endothelial keratoplasty (DMEK) surgery in terms of endothelial cell density (ECD) and preparation failure.Methods and AnalysisWe explored ECD during donor tissue preparation in 2076 grafts. Preparation failure was analysed in 1028 grafts used in DMEK surgery at our clinic. To monitor ECD and functional results, we matched 86 DMEK patients who received pseudophakic donor grafts with similar recipients of phakic donor grafts and followed them up for 36 months.ResultsAt recovery, mean ECD in pseudophakic donor grafts was 2193 cells/mm2 (SD 28.7) and 2364 cells/mm2 (SD 15.7) in phakic donor grafts (p<0.001). After cultivation, the difference increased as pseudophakic donor grafts lost 14% of ECD while phakic lost only 6% (p<0.001). At transplantation, mean ECD in pseudophakic donor grafts was 2272 cells/mm2 (SD 250) and 2370 cells/mm2 (SD 204) in phakic donor grafts (p<0.001). After transplantation, the difference in ECD increased as pseudophakic donor grafts lost 27.7% of ECD while phakic donor grafts lost only 13.3% (p<0.001). The risk of preparation failure in pseudophakic donor grafts was higher than in phakic donor grafts (OR 4.75, 95% CI 1.78 to 12.67, p=0.02). Visual acuity increased in both groups similarly.ConclusionsPseudophakic donor grafts have a lower ECD, are more prone to endothelial cell loss during recovery and surgery and are associated with a higher risk of preparation failure. Cornea banks and surgeons should consider this in the planning of graft preparation and transplantation.

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Clinical Evaluation of the NS Endo-Inserter, a Novel Donor Inserter for Descemet’s Stripping Automated Endothelial Keratoplasty

Case Reports in Ophthalmology ◽

10.1159/000503441 ◽

2019 ◽

Vol 10 (3) ◽

pp. 357-364

Author(s):

Akira Kobayashi ◽

Hideaki Yokogawa ◽

Natsuko Mori ◽

Tsubasa Nishino ◽

Kazuhisa Sugiyama

Keyword(s):

Anterior Chamber ◽

Clinical Outcomes ◽

Intraoperative Complications ◽

Case Series ◽

Argon Laser ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Donor Tissue ◽

Laser Iridotomy ◽

Cell Densities

Purpose: This study investigated the clinical outcomes achieved with a newly developed donor inserter (NS Endo-Inserter [NSI], HOYA Co., Ltd., Tokyo, Japan) for Descemet’s stripping automated endothelial keratoplasty (DSAEK) in Japanese eyes with bullous keratopathy secondary to argon laser iridotomy (BK-ALI). The NSI device utilizes pressure flow to push the DSAEK donor tissue into the anterior chamber. Methods: Six eyes of 6 patients (1 male, 5 females; mean age, 78.5 years) with BK-ALI were enrolled. Donor tissue was pushed into the anterior chamber using the NSI. Intraoperative complications, graft dislocation, and iatrogenic primary graft failure were recorded for all eyes. Six-month postoperative central donor endothelial cell densities (ECD) were measured prospectively and compared with preoperative values, along with 6-month best corrected visual acuity (BCVA). Results: In all cases, donor loading onto the NSI spatula and donor insertion into the anterior chamber using the NSI was smooth and successful; no intraoperative complications were noted. There were no cases of graft dislocation or IPGF. Postoperative ECD was 2,187.2 cells/mm2 (mean loss, 14.8%) and mean BCVA increased from 0.27 decimal to 0.8 at 6 months. Conclusion: In this small preliminary case series, clinical outcomes for patients with BK-ALI undergoing DSAEK using the NSI were comparable or better than those achieved with conventional DSAEK insertion techniques.

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