Marty Anne-Sophie, Burillon Carole, Desanlis Adeline, Damour Odile, Kocaba Viridiana, Auxenfans Céline
Ophthalmology Department, Edouard Herriot Hospital, 5, place d'Arsonval, 69003, Lyon, France.
Cells and Tissue Bank of Hospices Civils de Lyon, Cornea Bank Department, Edouard Herriot Hospital, 5, place d'Arsonval, 69003, Lyon, France.
Cell Tissue Bank. 2016 Jun;17(2):225-32. doi: 10.1007/s10561-016-9544-y. Epub 2016 Mar 2.
Descemet Membrane Endothelial Keratoplasty (DMEK) selectively replaces the damaged posterior part of the cornea. However, the DMEK technique relies on a manually-performed dissection that is time-consuming, requires training and presents a potential risk of endothelial graft damages leading to surgery postponement when performed by surgeons in the operative room. To validate precut corneal tissue preparation for DMEK provided by a cornea bank in order to supply a quality and security precut endothelial tissue. The protocol was a technology transfer from the Netherlands Institute for Innovative Ocular Surgery (NIIOS) to Lyon Cornea Bank, after formation in NIIOS to the DMEK "no touch" dissection technique. The technique has been validated in selected conditions (materials, microscope) and after a learning curve, cornea bank technicians prepared endothelial tissue for DMEK. Endothelial cells densities (ECD) were evaluated before and after preparation, after storage and transport to the surgery room. Microbiological and histological controls have been done. Twenty corneas were manually dissected; 18 without tears. Nineteen endothelial grafts formed a double roll. The ECD loss after cutting was 3.3 % (n = 19). After transportation 7 days later, we found an ECD loss of 25 % (n = 12). Three days after cutting and transportation, we found 2.1 % of ECD loss (n = 7). Histology found an endothelial cells monolayer lying on Descemet membrane. The mean thickness was 12 ± 2.2 µm (n = 4). No microbial contamination was found (n = 19). Endothelial roll stability has been validated at 3 days in our cornea bank. Cornea bank technicians trained can deliver to surgeons an ECD controlled, safety and ready to use endothelial tissue, for DMEK by "no touch" technique, allowing time saving, quality and security for surgeons.
深板层角膜内皮移植术（DMEK）选择性地替换受损的角膜后部。然而，DMEK技术依赖于手动进行的剥离，这既耗时，又需要培训，而且在手术室由外科医生操作时，还存在内皮移植片受损导致手术延期的潜在风险。为了验证角膜库提供的用于DMEK的预切割角膜组织制备，以供应高质量和安全的预切割内皮组织。该方案是从荷兰创新眼外科研究所（NIIOS）向里昂角膜库的技术转移，NIIOS在此之前形成了DMEK“无接触”剥离技术。该技术在选定的条件（材料、显微镜）下经过验证，并经过学习曲线后，角膜库技术人员为DMEK制备内皮组织。在制备前、制备后、储存后以及运输到手术室后评估内皮细胞密度（ECD）。进行了微生物学和组织学检查。20只角膜进行了手动剥离；18只无撕裂。19个内皮移植片形成了双卷。切割后ECD损失为3.3%（n = 19）。7天后运输后，我们发现ECD损失为25%（n = 12）。切割和运输3天后，我们发现ECD损失为2.1%（n = 7）。组织学检查发现内皮细胞单层位于后弹力层上。平均厚度为12±2.2μm（n = 4）。未发现微生物污染（n = 19）。我们的角膜库在3天时验证了内皮卷的稳定性。经过培训的角膜库技术人员可以通过“无接触”技术为外科医生提供ECD可控、安全且随时可用的内皮组织，为外科医生节省时间、保证质量和安全。
