FP209 : Surgeon’s Donor Roll Preparation in DMEK: MK medium and Cornisol Medium Preserved Cornea.

Dr. Soham Basak, B16308, Dr.Samar Kumar Basak, Dr. Viraj Rajiv Pradhan

Descemet membrane endothelial keratoplasty (DMEK) is becoming the surgery of choice in endothelial diseases. The preparation of the graft by the surgoen is crucial as it reduces the cost of the corneal graft as compared to DM roll preparation by the eye bank.Various publications have emphasied , on Optisol-GS,or Life4C or organ culture as the storage media in eye bank prepared roll, all of which are expensive storag media as compred to McCarey-Kaufman medium.

The purpose of this study wasto determine the donor peeling time and DM tear rate between cornea stored in two different and less expensive  McCarey-Kaufman medium (MKM) and Corsinol medium (CSM) – media during DMEK graft preparation.

Methods: Nonrandomized comparative study.105 consecutive DMEK donor tissueswere used: 52 preserved in MKM and 53 in CSM. DMEK graft was prepared by same surgeon using the same technique. The data analyzed included donor age, behavior of DM form the same donor peel time, and rate of DM tear.
Results: Overall, the success rate of DMEK graft preparation was 97.1%. Average peel time was 7.5±2.9 min; MKM had a little faster peel time (7.4±2.2) min than CSM (7.6 ± 3.3) although this was not statistically significant (p=0.65). DM tears were noted in 3 eyes (3%); 1 in CSM and 2 in MKM.

The peel time for donors  less than 55 years, 55 to 65 years and more 65 years was 6.5 ± 2.4 mins, 7.1 ± 2.6 mins and 7.6 ± 3.1 mins respectively. Although the peel time in younger donors was less, it was not significant (ANOVA p=0.46). The ease of peeling was best experienced in donor age 55 to 65 years. Peel times for 2 corneas from the same donor was noted to be similar irrespective of media (P=0.37). Interestingly, the donor preparation time improved significantly over time as the surgeon’s experience increased. The mean time for DM roll preparation time improved from 10±2.8 mins for first 25 eyes to 7.4±2.1 mins and 6.1±1.8 mins for the next sets of 25 eyes and was 5.4±1.6 mins for the last 30 eyes. Comparing with the first 25 eyes, the subsequent DM preparation times were significantly faster (p<0.001).
Conclusion: Surgeon’sDMEK graft preparation is highly satisfactory with corneas preserved in less expensive MK and Cornisol medium with high success rate. There was no difference observed between the media in terms of peel time and complication rates. Paired tissues tended to behave similarly. And, the peel time became significantly faster with increasing surgeon experience.

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