title: Analysis of the learning curve for pre-cut corneal specimens in preparation for lamellar transplantation: a prospective, single-centre, consecutive case series prepared at the Lions New South Wales Eye Bank.
abstract: OBJECTIVE
  This study is the first paper to establish a learning curve by a single technician.
  
  
  BACKGROUND
  Preparation of pre-cut corneal endothelial grafts commenced at Lions New South Wales Eye Bank in December 2014. The primary objective of this study was to review the safety and reliability of the preparation method during the first year of production.
  
  
  METHODS
  This is a hospital-based, prospective case series.
  
  
  METHODS
  There were 234 consecutive donor corneal lenticules.
  
  
  METHODS
  Donor lenticules were prepared by a single operator using a linear cutting microkeratome. Immediately prior to cutting, central corneal thickness values were recorded. Measurements of the corneal bed were taken immediately following lenticule preparation. Outcomes were separated by blade sizes, and intended thickness was compared to actual thickness for each setting. Early specimens were compared to later ones to assess for a learning curve within the technique.
  
  
  METHODS
  The main parameter measured is the mean difference from intended lamellar cut thickness.
  
  
  RESULTS
  The mean final cut thickness was 122.36 ± 20.35 μm, and the mean difference from intended cut was 30.17 ± 37.45 μm. No significant difference was found between results achieved with early specimens versus those achieved with later specimens (P = 0.425).
  
  
  CONCLUSIONS
  Thin, reproducible endothelial grafts can routinely be produced by trained technicians at their respective eye banks without significant concerns for an extended learning curve. This service can reduce perioperative surgical complexity, required surgical paraphernalia and theatre times. The consistent preparation of single-pass, ultrathin pre-cut corneas may have additional advantages for surgeons seeking to introduce lamellar techniques.
authors.affiliation: Vision Eye Institute, Sydney, New South Wales, Australia.|Lions NSW Eye Bank, Sydney, New South Wales, Australia.
authors.forename: Aifric Isabel
authors.identifier: http://orcid.org/0000-0001-6119-1582
authors.initials: AI
authors.lastname: Martin
authors.affiliation: Lions NSW Eye Bank, Sydney, New South Wales, Australia.
authors.forename: Rajnesh
authors.initials: R
authors.lastname: Devasahayam
authors.affiliation: Vision Eye Institute, Sydney, New South Wales, Australia.|Lions NSW Eye Bank, Sydney, New South Wales, Australia.|Graduate School of Health, University of Technology, Sydney, New South Wales, Australia.
authors.forename: Christopher
authors.identifier: http://orcid.org/0000-0002-0516-6486
authors.initials: C
authors.lastname: Hodge
authors.affiliation: Lions NSW Eye Bank, Sydney, New South Wales, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Cooper
authors.affiliation: Vision Eye Institute, Sydney, New South Wales, Australia.|Lions NSW Eye Bank, Sydney, New South Wales, Australia.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Gerard L
authors.initials: GL
authors.lastname: Sutton
mesh_terms: D002452:Cell Count; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal; D005125:Eye Banks / Q000379:methods*; D006801:Humans; D059032:Learning Curve; D009517:New South Wales; D011446:Prospective Studies; D015203:Reproducibility of Results; D013048:Specimen Handling; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting
keywords: corneal endothelium; corneal transplantation; eye banking; lamellar keratoplasty