@article {1635620,
	title = {Factors Affecting the Success Rate of Preloaded Descemet Membrane Endothelial Keratoplasty With Endothelium-Inward Technique: A Multicenter Clinical Study},
	journal = {Am J Ophthalmol},
	volume = {241},
	year = {2022},
	month = {2022 09},
	pages = {272-281},
	abstract = {PURPOSE: To evaluate factors affecting the outcomes of preloaded Descemet membrane endothelial keratoplasty (pl-DMEK) with endothelium-inward. DESIGN: Retrospective clinical case series and a comparative tissue preparation study. METHODS: Participants: Fifty-five donor tissues for ex vivo study and 147 eyes of 147 patients indicated with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy with or without cataract. INTERVENTION: Standardized DMEK peeling was performed with 9.5-mm-diameter trephination followed by second trephination for loading the graft (8.0-9.5 mm diameter). The tissues were manually preloaded with endothelium-inward and preserved for 4 days or shipped for transplantation. Live and dead assay and immunostaining was performed on ex vivo tissues. For the clinical study, the tissues were delivered using bimanual pull-through technique followed by air tamponade at all the centers. MAIN OUTCOME MEASURES: Tissue characteristics, donor and recipient factors, rebubbling rate, endothelial cell loss (ECL), and corrected distance visual acuity (CDVA) at 3, 6, and 12 months. RESULTS: At day 4, significant cell loss (P\&nbsp;=\&nbsp;.04) was observed in pl-DMEK with loss of biomarker expression seen in prestripped and pl-DMEK tissues. Rebubbling was observed in 40.24\% cases. Average ECL at 3, 6, and 12 months was 45.87\%, 40.98\%, and 47.54\%, respectively. CDVA improved significantly at 3 months postoperation (0.23 {\textpm} 0.37 logMAR) (P \&lt; .01) compared to the baseline (0.79 {\textpm} 0.61 logMAR). A significant association (P \&lt; .05) between graft diameter, preservation time, recipient gender, gender mismatch, and recipient age to rebubbling rate was observed. CONCLUSION: Graft loading to delivery time of pl-DMEK tissues in endothelium-inward fashion must be limited to 4 days after processing. Rebubbling rate and overall surgical outcomes following preloaded DMEK can be multifactorial and center-specific.},
	keywords = {Cell Count, Corneal Endothelial Cell Loss, Descemet Membrane, Descemet Stripping Endothelial Keratoplasty, Endothelium, Corneal, Fuchs{\textquoteright} Endothelial Dystrophy, Humans, Retrospective Studies},
	issn = {1879-1891},
	doi = {10.1016/j.ajo.2022.03.009},
	author = {Parekh, Mohit and Pedrotti, Emilio and Viola, Pietro and Leon, Pia and Neri, Enrico and Bosio, Lorenzo and Bonacci, Erika and Ruzza, Alessandro and Kaye, Stephen B and Ponzin, Diego and Ferrari, Stefano and Romano, Vito}
}
