Preloaded tissue for DSEK saves time, reduces stress

A surgeon says that an eye bank may be the best choice for this kind of tissue preparation.

Issue: March 10, 2017

Corneal surgeons collaborating with eye banks to use preloaded donor graft tissue for endothelial keratoplasty can significantly reduce operating time and reduce intraoperative tissue manipulation during Descemet’s stripping endothelial keratoplasty for Fuchs’ endothelial dystrophy procedures.

Complications were few and endothelial cell loss was low for DSEK procedures when surgeons used grafts preloaded by an eye bank in a commercially available insertion device, Kathryn A. Colby, MD, PhD, told Ocular Surgery News.

“Preloaded tissue reduces the surgical time of my cases, and I don’t have the stress of having to trephine and load my own tissue. It took me maybe 10 minutes to prepare the tissue because I do it under a microscope. You have to put the tissue out on the block, move the microscope over to the back table, trephine the tissue and then load it into the inserter, and then move the microscope back to the patient. If you’re not doing it day in and day out, you’re not going to be as good as someone whose job it is to cut and load tissue. It really improved time of surgery and is less stressful for surgeons, especially for those of us who train residents and fellows,” Colby said.

Few complications

Colby and colleagues included 35 eyes of 34 consecutive patients in a retrospective case series evaluating DSEK for Fuchs’ endothelial dystrophy or previously failed full-thickness grafts. The surgeons used donor tissue that had undergone pre-lamellar dissection, trephination and loading into an EndoGlide ultrathin inserter (AngioTech). The tissue was prepared by the Lions Eye Institute for Transplant and Research in Tampa, Florida. The patients were evaluated for intraoperative and postoperative complications and endothelial cell loss at 3, 6 and 12 months, Colby said.

Each surgery was completed within 24 hours after tissue preparation and loading by the eye bank. At final follow-up, researchers noted one primary graft failure, one graft rejection and two cases of re-bubbling.

Less endothelial cell loss

After the procedure, mean best corrected visual acuity of all patients improved to 20/25 from 20/100 preoperatively. Additionally, at 6 months postoperatively, mean endothelial cell loss was 25.3%, which remained stable throughout 1 year, Colby said.

Using a preloaded graft reduced surgical stress for the surgeons during the procedure, Colby said.

“We’re always trying to improve efficiency in the operating room and also improve outcomes in patients. In the history of DSEK, the thing that was most influential in getting surgeons to accept this technique was when the eye banks began precutting the tissue. A surgeon didn’t have to take responsibility for that step. They didn’t have to take the risk of them cutting through a tissue or damaging it. It makes a lot of sense that an eye bank whose job it is to process tissues day in and day out are the best people to do this kind of tissue preparation,” Colby said.

The use of preloaded eye grafts from eye banks is “innovative,” and “corneal surgeons really can make an impact in the care of patients by working with their eye banks to improve what we do and how we do it.”

“Preloaded DSEK tissue can be safely used for endothelial keratoplasty without undue surgical complications or endothelial cell loss,” she said. – by Robert Linnehan

Reference:
Palioura S, et al. Cornea. 2017;doi:10.1097/ICO.0000000000001039.

For more information:
Kathryn A. Colby, MD, PhD, can be reached at University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., MC2114, Chicago, IL 60637; email: kcolby@bsd.uchicago.edu.

Disclosure: Colby reports no relevant financial disclosures.