title: Outcomes of Descemet Stripping Endothelial Keratoplasty Using Eye Bank-Prepared Preloaded Grafts.
abstract: OBJECTIVE
  To evaluate the feasibility of Descemet stripping endothelial keratoplasty using grafts preloaded by an eye bank in a commercially available insertion device.
  
  
  METHODS
  In this retrospective case series, a series of 35 eyes in 34 consecutive patients who underwent Descemet stripping endothelial keratoplasty for Fuchs endothelial dystrophy or previously failed full-thickness grafts at a single tertiary care center from March 2013 to March 2014 was included. The donor tissue had undergone pre-lamellar dissection, trephination, and loading into EndoGlide Ultrathin inserters at the Lions Eye Institute for Transplant and Research (Tampa, FL) and was shipped overnight in Optisol GS to the surgeon (K.C.). Surgery was performed within 24 hours from tissue preparation and loading by the eye bank. Donor and recipient characteristics, endothelial cell density (ECD), best-corrected visual acuity, and central corneal thickness were recorded. The main outcome measures were intraoperative and postoperative complications and ECD loss at 3, 6, and 12 months.
  
  
  RESULTS
  One primary graft failure (2.8%), 2 rebubblings (5.7%), and 1 graft rejection (2.8%) occurred. Mean preoperative donor ECD was 2821 ± 199 cells/mm. Six months postoperatively, the mean endothelial cell loss was 25.3% ± 17.2% (n = 32), which remained stable at 1 year (31.5% ± 17.9%, n = 32). Mean best-corrected visual acuity improved from 20/100 preoperatively to 20/25 at a mean follow-up of 1 year (n = 32). Mean central corneal thickness was reduced from 711 ± 110 μm to 638 ± 66 μm at the last follow-up visit.
  
  
  CONCLUSIONS
  Donor graft tissue preloaded by an eye bank can be used successfully for endothelial keratoplasty. Preloading reduces intraoperative tissue manipulation.
authors.affiliation: *Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA; †Cornea Service, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and ‡Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, IL.
authors.forename: Sotiria
authors.initials: S
authors.lastname: Palioura
authors.forename: Kathryn
authors.initials: K
authors.lastname: Colby
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003315:Cornea / Q000473:pathology; D055954:Corneal Endothelial Cell Loss / Q000473:pathology; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D042783:Endothelial Cells / Q000166:cytology; D005125:Eye Banks / Q000379:methods; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000473:pathology / Q000601:surgery*; D006084:Graft Rejection / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014792:Visual Acuity