title: Comparison of Gebauer SLc and Moria CBm Carriazo-Barraquer ALK Microkeratomes for Descemet's Stripping Automated Endothelial Keratoplasty Preparation.
abstract: OBJECTIVE
  We compared the hand-guided Moria Carriazo-Barraquer (CBm) microkeratome with the fully automatic SLc microkeratome for Descemet's stripping automated endothelial keratoplasty (DSAEK)-lamella preparation and storage, vis-à-vis accuracy, endothelial cell loss (ECL), and lamellar surface roughness (LSR).
  
  
  METHODS
  A total of 18 human corneas were dissected with both the 300 μm CBm multi-use (n = 9) and the 300 µm SLc (n = 9) single-use heads, after which they were incubated for 6 d in a 5% dextran medium. Before preparation (0 h) and 1, 24, and 144 h after dissection, ECL and corneal thickness (CT) were measured by ultrasound pachymetry (USP) and optical coherence tomography (OCT). LSR was assessed by scanning electron microscopy (SEM) and evaluated by three masked observers.
  
  
  RESULTS
  Prior to cutting, CTs did not differ significantly between OCT or USP measurements, with a high correlation between the two modalities (r(2)= 0.94, p < 0.0001). One hour after preparation the anterior lamella showed a significantly higher dissection depth with the CBm (429.4 ± 21.8 µm) than the SLc (311.7 ± 54.8 µm, p = 0.0006), with the variance of the SLc system showing a trend towards higher values (p = 0.07). Anterior and posterior lamellae swelled significantly in the subsequent culture period. Both groups showed a significant ECL 1 h after preparation (p < 0.0001) with no significant difference between the systems (1 h: p = 0.44; CBm: - 9.4%, SLc: -11.7%), which stabilized over 144 h (144 h CBm: -13.9%, 144 h SLc: -10.3%). LSR did not differ significantly between both systems (p = 0.60).
  
  
  CONCLUSIONS
  The SLc system agrees more with the designated cutting depth than the CBm. The dissection produced a comparable LSR and a ∼10% ECL independently of the system. Further incubation of the prepared lamellae led to a swelling, but no further ECL.
authors: a Department of Ophthalmology , RWTH Aachen University , Aachen , Germany.
authors: Matthias
authors: M
authors: Fuest
authors: a Department of Ophthalmology , RWTH Aachen University , Aachen , Germany.
authors: Sabine
authors: S
authors: Salla
authors: a Department of Ophthalmology , RWTH Aachen University , Aachen , Germany.
authors: Peter
authors: P
authors: Walter
authors: a Department of Ophthalmology , RWTH Aachen University , Aachen , Germany.
authors: Niklas
authors: N
authors: Plange
authors: a Department of Ophthalmology , RWTH Aachen University , Aachen , Germany.
authors: David
authors: D
authors: Kuerten
authors: a Department of Ophthalmology , RWTH Aachen University , Aachen , Germany.
authors: Ansgar
authors: A
authors: Flammersfeld
authors: a Department of Ophthalmology , RWTH Aachen University , Aachen , Germany.
authors: Martin
authors: M
authors: Hermel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis; D063171:Corneal Pachymetry; D057111:Descemet Stripping Endothelial Keratoplasty / Q000295:instrumentation*; D004728:Endothelium, Corneal / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D009924:Organ Culture Techniques; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D041623:Tomography, Optical Coherence
keywords: Corneal transplantation; Descemet’s stripping automated endothelial keratoplasty; lamellar graft; organ culture