Comparison of preloaded grafts for Descemet membrane endothelial keratoplasty (DMEK) in a novel preloaded transport cartridge compared to conventional precut grafts.

To determine the safety and graft quality of eye bank precut and preloaded grafts for Descemet membrane endothelial keratoplasty (DMEK) after storage and shipping in a novel preloaded transport cartridge compared to precut grafts in a conventional viewing chamber. In this laboratory proof-of-concept study, 29 human donor corneas that were unsuitable for transplantation with a mean endothelial cell density of 1948 ± 260 cells/mm2 were prepared using liquid bubble technique for producing precut lamellar grafts. The grafts were either preloaded into novel transport cartridge (n = 16) or transferred into conventional Krolman viewing chamber (control, n = 13). Grafts were stored for 24 or 48 h in dextran-containing medium at room temperature and subjected to a shipping simulation. Endothelial cell loss (ECL) and morphology were determined at different steps. Endothelial cell viability staining was performed with calcein dye. Mean ECL in the preloaded transport cartridge was 0.7% ± 1.2% after 24 h and 3.4% ± 1.2% (p = 0.006) after 48 h storage and injection. In the control group the ECL was mean 1.6% ± 2.7% after 24 h compared to 3.7% ± 0.9% (p = 0.042) after 48 h. The slightly higher endothelial cell loss in the viewing chamber group after 48 h was not statistically significant compared to the preloaded transport cartridge (p = 0.8). Calcein staining was comparably low in all groups and correlated with the low ECL in both groups. DMEK grafts can be preloaded into a novel transport cartridge using a "no touch" technique, stored and shipped for up to 2 days in dextran-containing medium without significant ECL.