Relationship Between Tissue Unscrolling Time and Endothelial Cell Loss

• Published in: Cornea Vol. 35; no. 4; pp. 471 - 476
• Main Authors: Sáles, Christopher S, Terry, Mark A, Veldman, Peter B, Mayko, Zachary M, Straiko, Michael D
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-04-2016
• Subjects: Adult; Aged; Aged, 80 and over; Cell Count; Corneal Endothelial Cell Loss - diagnosis; Corneal Endothelial Cell Loss - physiopathology; Descemet Stripping Endothelial Keratoplasty; Endothelium, Corneal - pathology; Endothelium, Corneal - transplantation; Female; Fuchs' Endothelial Dystrophy - surgery; Humans; Intraoperative Period; Male; Middle Aged; Operative Time; Tissue Donors
• ISSN: 0277-3740; 1536-4798
• DOI: 10.1097/ICO.0000000000000771

PURPOSE:To assess the relationship between intraoperative unscrolling time of the donor Descemet membrane endothelial keratoplasty (DMEK) tissue and 6-month postoperative endothelial cell loss (ECL), and to determine whether donor age, scroll tightness, and the presence of an S stamp are related to unscrolling time.
METHODS:Ninety-three consecutive uncomplicated DMEK surgeries performed on eyes with Fuchs endothelial dystrophy using our standardized technique (ie, prestripped tissue with or without a premarked S stamp from our eye bank, overstripping the recipient, Straiko glass injector, no-touch tap technique, and bubble of 20% SF6 gas) were evaluated. Intraoperative unscrolling times and 6-month endothelial cell densities were measured and analyzed.
RESULTS:Sixty-nine cases comprised the study cohort. The median unscrolling time was 4 minutes (range0.8–17.5 minutes), and the median ECL was 26.9% (range−4.3% to 80.0%). There was no relationship between unscrolling time and ECL at 6 months by the Pearson correlation coefficient (r = −0.02, P = 0.89). Younger donor age, tighter scrolls, and absence of an S stamp had no correlation with longer unscrolling times (all P > 0.05). Only 2 of 4 cases of iatrogenic primary graft failure had unscrolling times available for analysis; in this limited sample, there was no association between iatrogenic primary graft failure and unscrolling time.
CONCLUSIONS:Once the DMEK tissue is safely in the anterior chamber, surgeons need not rush the “DMEK dance” because longer unscrolling times may not endanger the endothelium.