预剥离、预装的Descemet膜内皮角膜移植片的评估与质量评估

Evaluation and Quality Assessment of Prestripped, Preloaded Descemet Membrane Endothelial Keratoplasty Grafts.

作者信息

Tran Khoa D, Dye Philip K, Odell Kelly, Galloway Joshua, Stoeger Christopher G, Straiko Michael D, Terry Mark A

机构信息

*Vision Research Laboratory, Lions VisionGift, Portland, OR; and †Cornea Service, Devers Eye Institute, Portland, OR.

出版信息

Cornea. 2017 Apr;36(4):484-490. doi: 10.1097/ICO.0000000000001150.

DOI:10.1097/ICO.0000000000001150

PMID:28129302

Abstract

PURPOSE

To determine graft quality and feasibility of Descemet membrane endothelial keratoplasty (DMEK) grafts that are prestripped and preloaded into injectors by eye bank technicians before shipping to surgeons.

METHODS

DMEK grafts (n = 31) were prepared from donor corneas and preloaded into Straiko Modified Jones tubes and set inside viewing chambers filled with 20 mL of Optisol-GS. Preloaded grafts were evaluated using specular microscopy and slit-lamp biomicroscopy. Endothelial cell loss (ECL) was captured by vital dye staining and quantified using FIJI. A subset of preloaded tissues was subjected to a shipping validation and 5-day storage assay. Fourteen additional DMEK grafts (not preloaded) were examined to quantify damage resulting from prestripping alone.

RESULTS

Specular microscopy was able to be performed for all preloaded tissues. Average ECL for preloaded tissues quantified by vital dye staining and FIJI after overnight storage was 16.8% ± 5.9%, and differed from slit-lamp ECL estimation by an average of 5.3% ± 3.6%. The average damage caused by prestripping alone was 9.3% ± 5.9%, and it was significantly less than that of preloaded tissues (P < 0.01). Average ECL for preloaded tissues subjected to round-trip shipping events was 18.5% ± 12.4%, and ECL for tissues stored at 4°C for 5 days after preloading was 13.1% ± 9.5%.

CONCLUSIONS

It is possible to prepare, evaluate, and ship DMEK grafts loaded inside a glass carrier and viewing chamber. The ability to evaluate tissues after processing allows for adherence to the Eye Bank Association of America Medical Standards, and for surgeons to receive the most accurate tissue information.

摘要

目的

确定在眼库技术人员将其预先剥离并预装到注射器中后再运送给外科医生的Descemet膜内皮角膜移植术（DMEK）移植物的质量和可行性。

方法

从供体角膜制备DMEK移植物（n = 31），并预装到Straiko改良琼斯管中，放置在装有20 mL Optisol - GS的观察室内。使用镜面显微镜和裂隙灯生物显微镜对预装的移植物进行评估。通过活体染料染色捕获内皮细胞损失（ECL），并使用FIJI进行量化。对一部分预装组织进行运输验证和5天储存试验。另外检查14个未预装的DMEK移植物，以量化仅预先剥离造成的损伤。

结果

能够对所有预装组织进行镜面显微镜检查。过夜储存后通过活体染料染色和FIJI量化的预装组织的平均ECL为16.8%±5.9%，与裂隙灯ECL估计值平均相差5.3%±3.6%。仅预先剥离造成的平均损伤为9.3%±5.9%，明显低于预装组织（P < 0.01）。经历往返运输的预装组织的平均ECL为18.5%±12.4%，预装后在4°C下储存5天的组织的ECL为13.1%±9.5%。