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Donor Tissue Culture Conditions and Outcome after Descemet Membrane Endothelial Keratoplasty

Published:February 21, 2011DOI:https://doi.org/10.1016/j.ajo.2010.11.027

      Purpose

      To investigate the effect of culture conditions of donor tissue on functional outcome after Descemet membrane endothelial keratoplasty.

      Design

      Retrospective, single-center, consecutive case series.

      Methods

      Descemet membrane endothelial keratoplasty was performed routinely in 82 eyes of 82 consecutive patients using corneal donor tissue prestored in either short-term culture (Optisol-GS; Bausch & Lomb) at 4 C (group A; n = 37) or organ culture (Dulbecco Modified Eagle Medium [Biochrom]; CorneaMax Medium [Eurobio]) at 34 C (group B; n = 45) in a randomized fashion. Main outcome measures included the number of air injections necessary for graft attachment as well as best-corrected visual acuity (in logarithm of the minimal angle of resolution [logMAR] units), central corneal thickness, and endothelial cell density at 1, 3, and 6 months after surgery.

      Results

      Best-corrected visual acuity increased from 0.69 ± 0.53 logMAR and 0.67 ± 0.31 logMAR before surgery to 0.33 ± 0.21 logMAR and 0.28 ± 0.18 logMAR after 1 month (P < .05), to 0.24 ± 0.16 logMAR and 0.18 ± 0.16 logMAR after 3 months (P < .05), and to 0.18 ± 0.12 logMAR and 0.15 ± 0.10 logMAR after 6 months (n.s.) in groups A and B, respectively. Endothelial cell density decreased from 2647 ± 236 cells/mm2 and 2515 ± 249 cells/mm2 before surgery to 1499 ± 277 cells/mm2 and 1526 ± 205 cells/mm2 after 1 month (P < .05), to 1441 ± 213 cells/mm2 and 1443 ± 316 cells/mm2 after 3 months (n.s.), and to 1587 ± 366 cells/mm2 and 1457 ± 285 cells/mm2 after 6 months (n.s.) in groups A and B, respectively. Central corneal thickness declined from 664 ± 89 and 662 ± 107 μm before surgery to 529 ± 92 μm and 517 ± 62 μm after 1 month (P < .05), to 511 ± 46 μm and 510 ± 46 μm after 3 months (P < .05), and to 529 ± 68 μm and 507 ± 50 μm after 6 months (n.s.) in groups A and B, respectively. Best-corrected visual acuity, endothelial cell density, and central corneal thickness values showed no significant differences between both groups at any time point after surgery. However, a significantly higher total number of air injections was necessary in group A (n = 34) compared with group B (n = 26) to obtain graft attachment (P < .05).

      Conclusions

      These findings suggest that donor tissue culture conditions have no significant effect on functional outcome, but may influence graft adhesion and rebubbling rate after Descemet membrane endothelial keratoplasty surgery.
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      Biography

      Friedrich E. Kruse, MD, is the Professor and Chairman, Department of Ophthalmology at the Erlangen University Medical School, Germany, since 2004. After graduation from Heidelberg Medical School in 1984, he worked at the Bascom Palmer Eye Institute, Miami, Florida from 1988 to 1991. His research interests include cellular and molecular biology of the ocular surface corneal transplantation and laser application.

      Biography

      Kathrin Laaser, MD, graduated from Munich Medical School (Technical University) in 2005. Since 2006 she has been a staff member in the Department of Ophthalmology at the University of Erlangen, Nuremberg, Germany. Dr. Laaser is presently receiving a fellowship training in corneal diseases at the Department of Ophthalmology, Erlangen University Medical School.