Karakus Sezen, Ighani Mehrnaz, Noparat Puntakarn, Tofigh Marjan, Chiang Eric, Barnes Kali, Chen Conan Y, Liu Tiffany S, Eghrari Allen O
Wilmer Eye Institute at Johns Hopkins, Baltimore, MD.
Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD.
Cornea. 2019 May;38(5):654-657. doi: 10.1097/ICO.0000000000001888.
In Descemet membrane endothelial keratoplasty (DMEK), loading and positioning of tri-folded grafts into a cartridge is generally conducted with forceps or a hook, risking graft tear or trauma. We demonstrate the feasibility of loading tri-folded grafts into a cartridge with no touch to the endothelium required beyond the tri-folding process.
A corneoscleral rim with a prestripped DMEK graft is placed into a petri dish. After the graft is tri-folded with forceps and removed from its stromal attachment, the graft is gently wicked into the tip of a saline-filled Alcon B IOL cartridge connected to IV extension tubing and a 3 cc syringe, drawn into the cartridge by positioning it adjacent to the graft tip. The remainder of the graft is aspirated with the addition of saline. The cartridge orientation is reversed for graft injection. In this retrospective analysis, we analyzed surgical videos for preparation times, and assessed postoperative visual acuity, pachymetry, and endothelial cell density.
Thirteen cases underwent this approach. Median preparation time from stain to cartridge eye contact was 8.5 minutes, and time from graft injection to final centration and bubbling was 2.9 minutes. Corneal thickness decreased from a median of 623 microns preoperatively to 566 μm at 1 month (P = 0.038). Visual acuity improved by 1 month by a median of 0.3 logarithm of the minimum angle of resolution (logMAR) (P = 0.016). Endothelial cell density decreased by 32.4% at 1 month compared with baseline.
Endothelium-in DMEK grafts may be loaded into a plastic cartridge using a skill set similar to aspiration of a scroll.
在Descemet膜内皮角膜移植术（DMEK）中，通常使用镊子或钩子将三折移植物装入药筒，这有导致移植物撕裂或损伤的风险。我们证明了在不触碰除三折过程之外的内皮的情况下，将三折移植物装入药筒的可行性。
将带有预剥离DMEK移植物的角膜缘置于培养皿中。用镊子将移植物三折并从其基质附着处取出后，将移植物轻轻吸至连接到静脉延长管和3 cc注射器的充满盐水的爱尔康B型人工晶状体药筒尖端，通过将药筒放置在移植物尖端附近将其吸入药筒。加入盐水后吸出移植物的其余部分。药筒方向反转以进行移植物注射。在这项回顾性分析中，我们分析了手术视频的准备时间，并评估了术后视力、角膜厚度测量和内皮细胞密度。
13例患者采用了这种方法。从染色到药筒接触眼睛的中位准备时间为8.5分钟，从移植物注射到最终定位和气泡形成的时间为2.9分钟。角膜厚度从术前的中位623微米降至1个月时的566微米（P = 0.038）。1个月时视力中位数提高了0.3最小分辨角对数（logMAR）（P = 0.016）。与基线相比，1个月时内皮细胞密度下降了32.4%。
DMEK移植物的内皮可使用类似于卷轴抽吸的技术装入塑料药筒。
