Donor Tissue Culture Conditions and Outcome after Descemet Membrane Endothelial Keratoplasty

• Published in: American journal of ophthalmology 2011-06, Vol.151 (6), p.1007-1018.e2
• Main Authors: Laaser, Kathrin, Bachmann, Bjoern O, Horn, Folkert K, Schlötzer-Schrehardt, Ursula, Cursiefen, Claus, Kruse, Friedrich E
• Format: Article
• Language: English
• Subjects: Adhesion; Adult; Aged; Aged, 80 and over; Bank management; Biological and medical sciences; Cell Count; Cell Survival; Corneal Edema - surgery; Corneal Endothelial Cell Loss - physiopathology; Descemet Stripping Endothelial Keratoplasty; Endothelium; Female; Follow-Up Studies; Fuchs' Endothelial Dystrophy - surgery; Graft Survival - physiology; Humans; Hypotheses; Male; Medical sciences; Microbiology; Middle Aged; Miscellaneous; Ophthalmology; Organ Culture Techniques; Retrospective Studies; Standard deviation; Surgery; Tissue Donors; Treatment Outcome; Visual Acuity - physiology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2010.11.027

Purpose To investigate the effect of culture conditions of donor tissue on functional outcome after Descemet membrane endothelial keratoplasty. Design Retrospective, single-center, consecutive case series. Methods Descemet membrane endothelial keratoplasty was performed routinely in 82 eyes of 82 consecutive patients using corneal donor tissue prestored in either short-term culture (Optisol-GS; Bausch & Lomb) at 4 C (group A; n = 37) or organ culture (Dulbecco Modified Eagle Medium [Biochrom]; CorneaMax Medium [Eurobio]) at 34 C (group B; n = 45) in a randomized fashion. Main outcome measures included the number of air injections necessary for graft attachment as well as best-corrected visual acuity (in logarithm of the minimal angle of resolution [logMAR] units), central corneal thickness, and endothelial cell density at 1, 3, and 6 months after surgery. Results Best-corrected visual acuity increased from 0.69 ± 0.53 logMAR and 0.67 ± 0.31 logMAR before surgery to 0.33 ± 0.21 logMAR and 0.28 ± 0.18 logMAR after 1 month ( P < .05), to 0.24 ± 0.16 logMAR and 0.18 ± 0.16 logMAR after 3 months ( P < .05), and to 0.18 ± 0.12 logMAR and 0.15 ± 0.10 logMAR after 6 months (n.s.) in groups A and B, respectively. Endothelial cell density decreased from 2647 ± 236 cells/mm2 and 2515 ± 249 cells/mm2 before surgery to 1499 ± 277 cells/mm2 and 1526 ± 205 cells/mm2 after 1 month ( P < .05), to 1441 ± 213 cells/mm2 and 1443 ± 316 cells/mm2 after 3 months (n.s.), and to 1587 ± 366 cells/mm2 and 1457 ± 285 cells/mm2 after 6 months (n.s.) in groups A and B, respectively. Central corneal thickness declined from 664 ± 89 and 662 ± 107 μm before surgery to 529 ± 92 μm and 517 ± 62 μm after 1 month ( P < .05), to 511 ± 46 μm and 510 ± 46 μm after 3 months ( P < .05), and to 529 ± 68 μm and 507 ± 50 μm after 6 months (n.s.) in groups A and B, respectively. Best-corrected visual acuity, endothelial cell density, and central corneal thickness values showed no significant differences between both groups at any time point after surgery. However, a significantly higher total number of air injections was necessary in group A (n = 34) compared with group B (n = 26) to obtain graft attachment ( P < .05). Conclusions These findings suggest that donor tissue culture conditions have no significant effect on functional outcome, but may influence graft adhesion and rebubbling rate after Descemet membrane endothelial keratoplasty surgery.