Preloaded Descemet Membrane Endothelial Keratoplasty Grafts With Endothelium Outward: A Cross-Country Validation Study of the DMEK Rapid Device

Cornea. 2021 Apr;40(4):484-490. doi: 10.1097/ICO.0000000000002493.

Abstract

Purpose: To validate the "Descemet membrane endothelial keratoplasty (DMEK) Rapid" device for the cross-country transportation of preloaded DMEK grafts preserved with endothelium outward.

Methods: DMEK grafts were stripped and loaded in the DMEK Rapid device with tissue culture medium (TCM) or transport medium (TM) with endothelium outward. The device was mounted in a 40-mL flask and preserved for 4 days on a rocker to simulate transportation (study A, n = 24) or shipped in the TM from Italy to the United Kingdom (study B, n = 9) and evaluated within 72 hours. All the tissues were stained with Alizarin red. Viability of the cells was checked postsimulations and posttransportation and was confirmed using live/dead staining. Expression of tight junction proteins was evaluated.

Results: In study A, the endothelial cell loss observed from the TCM group was 20.8% (±5.2) compared with 19.5% (±6.7) from the TM group (P = 0.41) after transport simulation. Alizarin red showed minimal uncovered areas in both groups. There were no statistical differences in viability between the TM (80.83%) and TCM groups (78.83%). In study B, 12.9% (±7.8) endothelial cell loss was observed after transporting the tissues from Italy to the United Kingdom with no significant difference between prestrip and posttransportation (P = 0.05). Alizarin red staining did not show any uncovered area. Live/dead analysis showed 85.16% cell viability after transportation. zonula occludens-1 (ZO-1) was expressed in all tissues.

Conclusions: The DMEK Rapid device is safe for preloading and shipping DMEK grafts internationally with endothelium outward within 72 hours when preserved in the transport media.

Publication types

  • Comparative Study
  • Validation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cell Survival / physiology
  • Descemet Stripping Endothelial Keratoplasty / instrumentation*
  • Endothelium, Corneal / cytology*
  • Endothelium, Corneal / physiology*
  • Female
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Specimen Handling / methods*
  • Tissue Donors
  • Tissue Preservation
  • Tissue and Organ Harvesting / methods
  • Tissue and Organ Procurement / methods*
  • Transportation / methods
  • United Kingdom
  • Zonula Occludens-1 Protein / metabolism

Substances

  • TJP1 protein, human
  • Zonula Occludens-1 Protein