Abstract
DMEK is the fastest-growing corneal transplant procedure for treating endothelial dysfunction in the USA. DMEK grafts prepared by eye banks save surgeons time in the operating room, eliminate failed tissue preparations performed by the surgeon, and provide post-processing quality assurance. While these benefits lower the barrier to DMEK adoption, establishment of a superb DMEK graft program is no easy task. A DMEK program requires careful consideration of tissue selection, staff training, post-processing tissue evaluation, and, perhaps most importantly, selection of a preparation technique.
This chapter will aid those who wish to establish an eye bank DMEK program as well as those who wish to refine an established program. The parameters of the Lions VisionGift DMEK program shall be discussed in detail, with a special focus on our approach to minimizing tissue loss.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bennett A, Mahmoud S, Drury D, Cavanagh HD, McCulley JP, Petroll WM, Mootha VV. Impact of Donor age on corneal endothelium-descemet membrane layer scroll formation. Eye Contact Lens. 2015;41(4):236–9. doi:10.1097/icl.0000000000000108.
Bourne WM, Johnson DH, Campbell RJ. The ultrastructure of Descemet’s membrane. III Fuchs’ dystrophy. Arch Ophthalmol. 1982;100(12):1952–5.
Burkhart ZN, Feng MT, Price MO, Price FW. Handheld slit beam techniques to facilitate DMEK and DALK. Cornea. 2013;32(5):722–4. doi:10.1097/ICO.0b013e31827797e7.
Eye Bank Association of America. 2014 Eye Banking Statistical Report. Washington D.C: Eye Bank Association of America; 2015.
Eye Bank Association of America. Medical Standards. Washington, D.C. 2015.
Giebel A, Francis W, Price J. Descemet’s Membrane Endothelial Keratoplasty (DMEK): The Bare Minimum. In: Francis W, Price J, Price MO, editors. DSEK: What You Need to Know About Endothelial Keratoplasty. Thorofare: Slack, Inc; 2009.
Gorovoy IR, Cui QN, Gorovoy MS. Donor tissue characteristics in preparation of DMEK grafts. Cornea. 2014;33(7):683–5. doi:10.1097/ico.0000000000000135.
Greiner MA, Rixen JJ, Wagoner MD, Schmidt GA, Stoeger CG, Straiko MD, Zimmerman MB, Kitzmann AS, Goins KM. Diabetes mellitus increases risk of unsuccessful graft preparation in Descemet membrane endothelial keratoplasty: a multicenter study. Cornea. 2014;33(11):1129–33. doi:10.1097/ico.0000000000000262.
Jardine GJ, Holiman JD, Stoeger CG, Chamberlain WD. Imaging and quantification of endothelial cell loss in eye bank prepared DMEK grafts using trainable segmentation software. Curr Eye Res. 2014;39(9):894–901. doi:10.3109/02713683.2014.887120.
Kelliher C, Engler C, Speck C, Ward D, Farazdaghi S, Jun AS. A comprehensive analysis of eye bank-prepared posterior lamellar corneal tissue for use in endothelial keratoplasty. Cornea. 2009;28(9):966–70. doi:10.1097/ICO.0b013e31819c4fcf.
Kruse FE, Laaser K, Cursiefen C, Heindl LM, Schlotzer-Schrehardt U, Riss S, Bachmann BO. A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea. 2011;30(5):580–7.
Maier AK, Gundlach E, Schroeter J, Klamann MK, Gonnermann J, Riechardt AI, Bertelmann E, Joussen AM, Torun N. Influence of the difficulty of graft unfolding and attachment on the outcome in descemet membrane endothelial keratoplasty. Graefe’s archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 2015. doi:10.1007/s00417-015-2939-9.
Mannis MJ, Holland EJ, Gal RL, Dontchev M, Kollman C, Raghinaru D, Dunn SP, Schultze RL, Verdier DD, Lass JH, Raber IM, Sugar J, Gorovoy MS, Sugar A, Stulting RD, Montoya MM, Penta JG, Benetz BA, Beck RW. The effect of donor age on penetrating keratoplasty for endothelial disease: graft survival after 10 years in the Cornea Donor Study. Ophthalmology. 2013;120(12):2419–27. doi:10.1016/j.ophtha.2013.08.026.
Muraine M, Gueudry J, He Z, Piselli S, Lefevre S, Toubeau D. Novel technique for the preparation of corneal grafts for descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2013;156(5):851–9. doi:10.1016/j.ajo.2013.05.041.
Phillips PM, Terry MA, Shamie N, Chen ES, Hoar KL, Stoeger C, Friend DJ, Saad HA. Descemet’s 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. 2009;28(8):871–6. doi:10.1097/ICO.0b013e318199f8d7.
Schlotzer-Schrehardt U, Bachmann BO, Tourtas T, Cursiefen C, Zenkel M, Rossler K, Kruse FE. Reproducibility of graft preparations in Descemet’s membrane endothelial keratoplasty. Ophthalmology. 2013;120(9):1769–77. doi:10.1016/j.ophtha.2013.06.038.
Steven P, Le Blanc C, Velten K, Lankenau E, Krug M, Oelckers S, Heindl LM, Gehlsen U, Huttmann G, Cursiefen C. Optimizing descemet membrane endothelial keratoplasty using intraoperative optical coherence tomography. JAMA Ophthalmol. 2013;131(9):1135–42. doi:10.1001/jamaophthalmol.2013.4672.
Tenkman LR, Price FW, Price MO. Descemet membrane endothelial keratoplasty donor preparation: navigating challenges and improving efficiency. Cornea. 2014;33(3):319–25. doi:10.1097/ico.0000000000000045.
Veldman PB, Dye PK, Holiman JD, Mayko ZM, Sales CS, Straiko MD, Galloway JD, Terry MA. The S-stamp in descemet membrane endothelial keratoplasty safely eliminates upside-down graft implantation. Ophthalmology. 2015. doi:10.1016/j.ophtha.2015.08.044.
Veldman PB, Dye PK, Holiman JD, Mayko ZM, Sales CS, Straiko MD, Stoeger CG, Terry MA. Stamping an S on DMEK donor tissue to prevent upside-down grafts: laboratory validation and detailed preparation technique description. Cornea. 2015;34(9):1175–8. doi:10.1097/ico.0000000000000522.
Vianna LM, Stoeger CG, Galloway JD, Terry M, Cope L, Belfort Jr R, Jun AS. Risk factors for eye bank preparation failure of descemet membrane endothelial keratoplasty (DMEK) tissue. Am J Ophthalmol. 2015. doi:10.1016/j.ajo.2015.01.030.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Stoeger, C.G., Galloway, J.D., Mayko, Z.M., Sáles, C.S. (2017). DMEK Graft Preparation: Eye Bank Perspective and Risk Factors for Preparation Failure. In: Cursiefen, C., Jun, A. (eds) Current Treatment Options for Fuchs Endothelial Dystrophy. Springer, Cham. https://doi.org/10.1007/978-3-319-43021-8_6
Download citation
DOI: https://doi.org/10.1007/978-3-319-43021-8_6
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-43019-5
Online ISBN: 978-3-319-43021-8
eBook Packages: MedicineMedicine (R0)