title: Stamping an S on DMEK Donor Tissue to Prevent Upside-Down Grafts: Laboratory Validation and Detailed Preparation Technique Description.
abstract: OBJECTIVE
  To report endothelial cell loss (ECL) caused by a novel S-stamp preparation technique for Descemet membrane endothelial keratoplasty (DMEK).
  
  
  METHODS
  Six cadaveric human corneas were prepared for DMEK transplantation using a single standardized technique, including the application of a dry ink gentian violet S-stamp to the stromal side of Descemet membrane. Endothelial cell death was evaluated and quantified using computerized analysis of vital dye staining.
  
  
  RESULTS
  ECL caused by the S-stamp was 0.6% (range 0.1%-1.0%), which comprised less than one-tenth of the total ECL caused by our preparation of the DMEK graft from the start to finish, including recovery, prestripping, S-stamping, and trephination (13.7% total ECL, range 9.9%-17.6%).
  
  
  CONCLUSIONS
  Our novel S-stamp donor tissue preparation technique is intuitive to learn and holds the promise of preventing iatrogenic primary graft failure due to upside-down grafts without causing unacceptable increases in ECL.
authors.affiliation: *Cornea Service, Massachusetts Eye and Ear Infirmary, Boston, MA; †Cornea Service, Devers Eye Institute, Portland, OR; and ‡Lions VisionGift, Portland, OR.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Veldman
authors.forename: Philip K
authors.initials: PK
authors.lastname: Dye
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Holiman
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Mayko
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Sáles
authors.forename: Michael D
authors.initials: MD
authors.lastname: Straiko
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Stoeger
authors.forename: Mark A
authors.initials: MA
authors.lastname: Terry
mesh_terms: D004396:Coloring Agents / Q000737:chemistry; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis; D057111:Descemet Stripping Endothelial Keratoplasty / Q000295:instrumentation / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005125:Eye Banks / Q000379:methods; D005840:Gentian Violet / Q000737:chemistry; D006085:Graft Survival; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007431:Intraoperative Complications / Q000517:prevention & control*; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*
chemical_list: D004396:Coloring Agents; D005840:Gentian Violet