title: Clinical outcomes of Descemet membrane endothelial keratoplasty using eye bank-prepared tissues.
abstract: OBJECTIVE
  To investigate the outcomes of Descemet membrane endothelial keratoplasty (DMEK) using prestripped donor tissue prepared by an eye bank.
  
  
  METHODS
  Retrospective, noncomparative case series.
  
  
  METHODS
  This retrospective, noncomparative, observational study investigated the outcomes of the first 40 consecutive DMEK procedures performed by a single surgeon using prestripped tissues prepared by a single eye bank during the period September 17, 2013 to July 1, 2014. A new technique to unfold the Descemet membrane grafts using a single cannula was described. Medical records were reviewed to obtain the prestripped and poststripped endothelial cell counts (ECC), postoperative ECC, visual acuity measurements, and complications.
  
  
  RESULTS
  Of the 43 prestripped tissues received, 40 were transplanted. The leading indications for DMEK were Fuchs endothelial corneal dystrophy (n = 28) and bullous keratopathy (n = 11). Nine DMEK procedures were performed in combination with phacoemulsification and posterior chamber intraocular lens implantation. Six patients had undergone prior glaucoma surgeries. The mean follow-up duration was 5.3 months (range, 1 week to 11 months). Preoperative spectacle-corrected visual acuity was ≤20/200 in 8 patients (20%) and ≤20/40 in 37 patients (92.5%). Primary graft failure occurred in the first case. Thirty-eight patients had improved vision postoperatively. Among the 39 patients who had successful DMEK, postoperative BCVA was ≥20/20 in 20 patients (51.2%), ≥20/25 in 30 patients (76.9%), and ≥20/40 in 34 patients (87.2%) by the last follow-up. There was no secondary graft failure. Rejection occurred in 2 patients because of self-discontinuation of topical corticosteroid. The most common complication was partial detachment requiring air injection (11 of 40 patients; 27.5%). Mean ECC loss after stripping of Descemet membrane was 3.9% (range, 6.5% gain to 14.5% loss). During the first 6 months after transplantation, the average ECC loss was 30.5% (range, 3.8%-67.4% loss).
  
  
  CONCLUSIONS
  DMEK using eye bank-prepared tissue achieved outcomes comparable to those reported for DMEK using surgeon-prepared tissue.
authors.affiliation: Cornea Division, Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California. Electronic address: deng@jsei.ucla.edu.
authors.forename: Sophie X
authors.initials: SX
authors.lastname: Deng
authors.affiliation: Cornea Division, Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
authors.forename: P James
authors.initials: PJ
authors.lastname: Sanchez
authors.affiliation: Cornea Division, Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
authors.forename: Luxia
authors.initials: L
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003886:Descemet Membrane; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal; D005125:Eye Banks / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D066027:Transplant Recipients; D014792:Visual Acuity / Q000502:physiology