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Non-invasive endothelial cell density measurement of in toto pre-stripped DMEK-roll – impact of pre- and intraoperative endothelial cell loss on postoperative midterm clinical outcome

Eye volume 37, pages 2956–2962 (2023)Cite this article

Subjects

Abstract

Background/Objectives

To measure the endothelial cell density (ECD) of the in toto pre-stripped endothelial Descemet membrane lamellae (EDML) and to describe the impact of pre- and intraoperative endothelial cell loss (ECL) on postoperative midterm clinical outcome.

Subjects/Methods

The ECD of 56 Corneoscleral Donor Discs (CDD) was first measured with an inverted specular microscope (t0pre). The measurement was then repeated non-invasively after the preparation of the EDML (t0post). DMEK was performed the next day using these grafts. Follow-up examinations took place 6 weeks, 6 months and 1 year postoperatively where the ECD was assessed. In addition, the impact of ECL 1 (during preparation) and ECL 2 (during surgery) on the ECD, visual acuity (VA) and pachymetry at 6 months and 1 year was investigated.

Results

The average ECD (in cells/mm²) at time points t0pre, t0post, 6 weeks, 6 months & 1 year was 2584 ± 200, 2355 ± 207, 1366 ± 345, 1091 ± 564 and 939 ± 352. The average logMAR VA and pachymetry (in µm) was 0.50 ± 0.27 and 597 ± 63, 0.23 ± 0.17 and 535 ± 54, 0.16 ± 0.12 and 535 ± 54, 0.06 ± 0.08 and 512 ± 37, respectively The ECL 1 (9% on average) had no significant impact on the main outcome measures after 6 months and 1 year (p > 0.11). The ECL 2 correlated significantly with the ECD and the pachymetry at 1 year postop (p < 0.02).

Conclusion

Our results indicate that the non-invasive ECD measurement of the prestripped EDML roll before its transplantation is feasible. Despite significantly decreasing ECD up to 6 months postoperatively, visual acuity further improved and thickness further decreased up to 1 year postoperatively.

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Fig. 1: Endothelial cell density (ECD; cells/mm2), Visual Acuity (VA; logMAR) and Pachymetry (Pachy; μm) over time.
Fig. 2

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Data availability

Data is available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank the Klaus Faber Center for Corneal Diseases, LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz for their help in preserving and measuring the donor corneas.

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  1. Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany

    Kolja Berg, Tarek Safi, Berthold Seitz & Loay Daas

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  1. Kolja Berg
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Contributions

KB was responsible for writing the manuscript, conducting the search, screening potentially eligible studies, extracting and analysing data, interpreting results and updating reference lists. TS was responsible for the preclinical trial (published earlier), research and feedback. BS and LD provided their professional support and feedback to the corresponding author.

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Correspondence to Kolja Berg.

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Berg, K., Safi, T., Seitz, B. et al. Non-invasive endothelial cell density measurement of in toto pre-stripped DMEK-roll – impact of pre- and intraoperative endothelial cell loss on postoperative midterm clinical outcome. Eye 37, 2956–2962 (2023). https://doi.org/10.1038/s41433-023-02450-x

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