Eye Bank Preparation of Tissue for Endothelial Keratoplasty

Key Concepts

• Eye banks have standardized the preparation of donor tissue for Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK).

• Eye bank preparation of donor tissue for endothelial keratoplasty reduces barriers to adopting endothelial keratoplasty techniques and increases operating room efficiency.

• The Cornea Preservation Time Study (CPTS), a prospective investigation of the effect of preservation time on DSAEK surgery outcomes, determined that the effect of preservation time on both graft success and postoperative endothelial cell loss was small up to 11 days preservation time.

• When preparing DSAEK tissue, a donor age of approximately 25 years or older may be most desirable due to increased corneoscleral rigidity.

• In DSAEK tissue preparation, the appropriate microkeratome blade depth is chosen based on the precut pachymetry measurement.

• Preparation of ultrathin DSAEK donor lenticules (<100 μm) may be achieved with either one or two microkeratome passes.

• Femtosecond laser DSAEK donor preparation is promising but more expensive compared with other methods.

• When preparing DMEK tissue, a donor age between 50 and 75 years is preferred due to improved ease of unscrolling the graft tissue during DMEK surgery.

• An “S” stamp can be placed on the stromal side of Descemet membrane that facilitates orientation of DMEK grafts during surgery.

• Eye bank preloading of DMEK graft tissue into an inserter may further improve operating room efficiency and permit increased adoption of this surgical technique.