title: Evaluation and Quality Assessment of Prestripped, Preloaded Descemet Membrane Endothelial Keratoplasty Grafts.
abstract: OBJECTIVE
  To determine graft quality and feasibility of Descemet membrane endothelial keratoplasty (DMEK) grafts that are prestripped and preloaded into injectors by eye bank technicians before shipping to surgeons.
  
  
  METHODS
  DMEK grafts (n = 31) were prepared from donor corneas and preloaded into Straiko Modified Jones tubes and set inside viewing chambers filled with 20 mL of Optisol-GS. Preloaded grafts were evaluated using specular microscopy and slit-lamp biomicroscopy. Endothelial cell loss (ECL) was captured by vital dye staining and quantified using FIJI. A subset of preloaded tissues was subjected to a shipping validation and 5-day storage assay. Fourteen additional DMEK grafts (not preloaded) were examined to quantify damage resulting from prestripping alone.
  
  
  RESULTS
  Specular microscopy was able to be performed for all preloaded tissues. Average ECL for preloaded tissues quantified by vital dye staining and FIJI after overnight storage was 16.8% ± 5.9%, and differed from slit-lamp ECL estimation by an average of 5.3% ± 3.6%. The average damage caused by prestripping alone was 9.3% ± 5.9%, and it was significantly less than that of preloaded tissues (P < 0.01). Average ECL for preloaded tissues subjected to round-trip shipping events was 18.5% ± 12.4%, and ECL for tissues stored at 4°C for 5 days after preloading was 13.1% ± 9.5%.
  
  
  CONCLUSIONS
  It is possible to prepare, evaluate, and ship DMEK grafts loaded inside a glass carrier and viewing chamber. The ability to evaluate tissues after processing allows for adherence to the Eye Bank Association of America Medical Standards, and for surgeons to receive the most accurate tissue information.
authors.affiliation: *Vision Research Laboratory, Lions VisionGift, Portland, OR; and †Cornea Service, Devers Eye Institute, Portland, OR.
authors.forename: Khoa D
authors.initials: KD
authors.lastname: Tran
authors.forename: Philip K
authors.initials: PK
authors.lastname: Dye
authors.forename: Kelly
authors.initials: K
authors.lastname: Odell
authors.forename: Joshua
authors.initials: J
authors.lastname: Galloway
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Stoeger
authors.forename: Michael D
authors.initials: MD
authors.lastname: Straiko
authors.forename: Mark A
authors.initials: MA
authors.lastname: Terry
mesh_terms: D000368:Aged; D002452:Cell Count; D002470:Cell Survival / Q000502:physiology*; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis; D003886:Descemet Membrane / Q000166:cytology / Q000502:physiology*; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000166:cytology / Q000502:physiology*; D005125:Eye Banks / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D066167:Slit Lamp; D013194:Staining and Labeling; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*