Livny Eitan, Groeneveld-van Beek Esther A, Lie Jessica T, Mangundap Kristin M, Bruinsma Marieke, Birbal Rénuka S, van der Wees Jacqueline, Melles Gerrit R J
*Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; †Melles Cornea Clinic, Rotterdam, the Netherlands; and ‡Amnitrans EyeBank, Rotterdam, the Netherlands.
Cornea. 2017 Dec;36(12):1452-1457. doi: 10.1097/ICO.0000000000001332.
To report the failure rate of 2 graft preparation techniques for Descemet membrane endothelial keratoplasty (DMEK) and to evaluate how to minimize graft preparation failure.
Retrospective, nonrandomized study at an eye bank specialized in graft preparation for lamellar keratoplasty. For 1416 donor corneas, the DMEK graft preparation failure rate was evaluated for 2 different techniques, technique I: "Standardized traditional technique" (n = 341) and technique II: "Standardized no-touch technique" (n = 933), and for grafts that were converted from technique II to technique I during preparation (n = 142).
The overall failure rate averaged 3.9% (55/1416): 7.0% (24/341) for technique I and 2.9% (31/1075) for technique II (P < 0.05). Tissue preparations which were converted from technique II to technique I failed in 13.4% (19/142), whereas for grafts that were entirely prepared by technique II, the failure rate was only 1.3% (12/933). The endothelial cell density decrease (before compared with after preparation) did not differ for both techniques (1.1% vs. 0.2%, P > 0.05).
Various DMEK graft preparation techniques may provide failure rates of <4%. A "no-touch preparation" approach (technique II) may combine good graft quality (completely intact endothelial cell layer, ie, negligible preparation-induced endothelial cell density decrease) with low risk of dissection failure, leaving the possibility of conversion to "traditional preparation" (technique I) as a backup method.
报告两种用于 Descemet 膜内皮角膜移植术（DMEK）的植片制备技术的失败率，并评估如何将植片制备失败率降至最低。
在一家专门从事板层角膜移植术植片制备的眼库进行回顾性、非随机研究。对于 1416 个供体角膜，评估了两种不同技术的 DMEK 植片制备失败率，技术 I：“标准化传统技术”（n = 341）和技术 II：“标准化无接触技术”（n = 933），以及在制备过程中从技术 II 转换为技术 I 的植片（n = 142）。
总体失败率平均为 3.9%（55/1416）：技术 I 为 7.0%（24/341），技术 II 为 2.9%（31/1075）（P < 0.05）。从技术 II 转换为技术 I 的组织制备失败率为 13.4%（19/142），而完全采用技术 II 制备的植片失败率仅为 1.3%（12/933）。两种技术的内皮细胞密度降低（制备前与制备后相比）无差异（1.1%对 0.2%，P > 0.05）。
各种 DMEK 植片制备技术的失败率可能低于 4%。“无接触制备”方法（技术 II）可能兼具良好的植片质量（内皮细胞层完全完整，即制备引起的内皮细胞密度降低可忽略不计）和较低的剖切失败风险，同时保留了转换为“传统制备”（技术 I）作为备用方法的可能性。
