Corneal Donor Tissue Preparation for Endothelial Keratoplasty

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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Descemetʼs Stripping Automated Endothelial Keratoplasty (DSAEK) Using Corneal Donor Tissue Not Acceptable for Use in Penetrating Keratoplasty as a Result of Anterior Stromal Scars, Pterygia, and Previous Corneal Refractive Surgical Procedures

Cornea ◽

10.1097/ico.0b013e318199f8d7 ◽

2009 ◽

Vol 28 (8) ◽

pp. 871-876 ◽

Cited By ~ 20

Author(s):

Paul M Phillips ◽

Mark A Terry ◽

Neda Shamie ◽

Edwin S Chen ◽

Karen L Hoar ◽

...

Keyword(s):

Surgical Procedures ◽

Penetrating Keratoplasty ◽

Endothelial Keratoplasty ◽

Donor Tissue ◽

Corneal Donor ◽

Corneal Donor Tissue

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QUALITY OF CORNEAL DONOR TISSUE IN THE GREATER THAN 75 YEAR AGE GROUP

Cornea ◽

10.1097/00003226-199603000-00055 ◽

1996 ◽

Vol 15 (2) ◽

pp. 526

Author(s):

Louis E. Probst ◽

Bridget A. Halfaker ◽

Edward J. Holland

Keyword(s):

Age Group ◽

Donor Tissue ◽

Corneal Donor ◽

Corneal Donor Tissue

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IMPROVED EVALUATION OF CORNEAL DONOR TISSUE WITH PHASE MICROSCOPY

Cornea ◽

10.1097/00003226-199301000-00054 ◽

1993 ◽

Vol 12 (1) ◽

pp. 92

Author(s):

M Bochnke

Keyword(s):

Donor Tissue ◽

Phase Microscopy ◽

Corneal Donor ◽

Corneal Donor Tissue

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Pre‐incubation of corneal donor tissue with sCD83 improves graft survival via the induction of alternatively activated macrophages and tolerogenic dendritic cells

American Journal of Transplantation ◽

10.1111/ajt.16824 ◽

2021 ◽

Author(s):

Katrin Peckert‐Maier ◽

Alfrun Schönberg ◽

Andreas B. Wild ◽

Dmytro Royzman ◽

Gabriele Braun ◽

...

Keyword(s):

Dendritic Cells ◽

Graft Survival ◽

Activated Macrophages ◽

Alternatively Activated Macrophages ◽

Donor Tissue ◽

Tolerogenic Dendritic Cells ◽

Alternatively Activated ◽

Corneal Donor ◽

Corneal Donor Tissue

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Preincubation of donor tissue with a VEGF cytokine trap promotes subsequent high-risk corneal transplant survival

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-319745 ◽

2021 ◽

pp. bjophthalmol-2021-319745

Author(s):

Wei Zhang ◽

Alfrun Schönberg ◽

Matthias Hamdorf ◽

Tihomir Georgiev ◽

Claus Cursiefen ◽

...

Keyword(s):

High Risk ◽

Graft Survival ◽

Corneal Transplantation ◽

Corneal Transplant ◽

Post Transplantation ◽

Human Igg ◽

Transplant Survival ◽

Donor Tissue ◽

Corneal Donor ◽

Corneal Donor Tissue

AimsPathological neovascularisation of the host bed and the transplant itself is the main risk factor for graft rejection after corneal transplantation. This study aims to prevent this process by preincubation of the corneal donor tissue ex vivo with an antivascular endothelial growth factor (VEGF) cytokine trap blocking additional postsurgical hemangiogenesis and lymphangiogenesis to promote high-risk graft survival.MethodsThe donor tissue was preincubated with a VEGFR1R2 cytokine trap for 24 hours prior to murine high-risk corneal transplantation (human IgG Fc was used as the control). The distribution of VEGFR1R2 Trap in the cornea was investigated by immunohistochemistry. Corneas were excised to quantify the blood vessels (BVs) and lymphatic vessels (LVs) and draining lymph nodes (dLNs) were harvested to analyse the phenotype of dendritic cells (DCs) and T cells at week 1, 2 and 8 post-transplantation. Graft survival was compared between preincubation with VEGFR1R2 Trap and human IgG Fc in high-risk recipients.ResultsVEGFR1R2 Trap was present in the graft for at least 2 weeks after surgery and additionally diffused into the corneal recipient. BVs, LVs and macrophages in the whole cornea were significantly decreased 1-week and 2-week post-transplantation (p<0.05). In dLNs the frequency of CD11c+DCs was significantly reduced, whereas CD200R+ regulatory DCs were significantly increased after keratoplasty (p<0.05). Furthermore, long-term high-risk graft survival was significantly improved (p<0.01).ConclusionsPreincubation of corneal donor tissue with a VEGFR1R2 cytokine trap can significantly promote subsequent high-risk corneal transplant survival and thereby opens new treatment avenues for high-risk corneal transplantation.

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Pre-Descemet’s endothelial keratoplasty: a simple, Descemet’s membrane scoring technique for successful graft preparation

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317613 ◽

2021 ◽

pp. bjophthalmol-2020-317613

Author(s):

Nicolas Cesario Pereira ◽

Adriana dos Santos Forseto ◽

Rafaela Cesario Pereira Maluf ◽

Harminder Singh Dua

Keyword(s):

Standard Technique ◽

Tissue Preparation ◽

Endothelial Keratoplasty ◽

Donor Tissue ◽

Descemet's Membrane ◽

Descemet’S Membrane ◽

Group 2 ◽

Group 1

PurposePre-Descemet’s endothelial keratoplasty (PDEK) donor tissue preparation involves the intrastromal injection of air to create a type 1 big bubble (BB) and avoidance of the creation of a type 2 BB. The purpose of this study was to design and test a technique to consistently creates a type 1 BB without risk of creating a type 2 BB.MethodsA prospective matched study with 64 human donor sclerocorneal discs, which were not suitable for corneal transplantation, was conducted. The corneas were divided into two groups, of which 32 were subjected to the standard technique of preparing the PDEK donor tissue (group 1, control) and 32 new technique, where in the donor Descemet’s membrane was scored with a Sinskey hook. Frequency of occurrence of different types of BB was compared and statistically analysed.ResultsWith the standard technique (group 1), type 1 BB occurred in 53.1%, type 2 BB in 34.4% and mixed BB in 12.5% of samples. With the scoring technique (group 2), a type 1 BB occurred in 100% of the samples. No type 2 or mixed BB occurred in any case in group 2. The difference in creation of a type 1BB between the two groups was statistically significant (p=0.00).ConclusionThe scoring technique is a simple, inexpensive and reproducible option to consistently achieve a type 1 BB to prepare PDEK graft tissue. The next step would be to study the clinical outcomes of PDEK performed with tissue obtained by the scoring technique.

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