The Last 200 Surgeon-Loaded Descemet Membrane Endothelial Keratoplasty Tissue Versus The First 200 Preloaded Descemet Membrane Endothelial Keratoplasty Tissue

Purpose: The purpose of this study was to compare the clinical outcomes from using eye bank-prepared, endothelium-out preloaded Descemet membrane endothelial keratoplasty (DMEK) tissue with those obtained with endothelium-out surgeon-loaded DMEK tissue using the same surgical technique at 1 site. Methods: This study retrospectively reviewed 400 consecutive cases of DMEK from March 2016 to April 2018. The last 200 cases using surgeon-loaded tissue were compared with the first 200 cases using preloaded tissue. Statistical analysis was performed using the Wilcoxon signed-rank test, binomial logistic regression, Kruskal-Wallis 1-way analysis of variance, Studentttest, or Pearson chi(2)tests. Results: Comparing surgeon-loaded versus preloaded DMEK tissue, respectively, no statistical difference was found in the mean 6-month postoperative values for endothelial cell loss (32.9% +/- 18.5% vs. 29.9% +/- 16.4%,P= 0.31), best corrected visual acuity (20/26 vs. 20/25,P= 0.54), or change in central corneal thickness (-14.4% +/- 8.9% vs. -15.6% +/- 11.7%,P= 0.43). The mean 1-year endothelial cell loss was also not significantly different (37.6% +/- 17.2% vs. 33.2% +/- 14.8%,P= 0.07). Overall, the rebubble rate for surgeon-loaded tissue was 17.5% and 12.5% for preloaded tissue, a statistically nonsignificant difference. Operative outcomes for mean tissue scroll tightness (1-4) and tissue unscroll time (minutes) for surgeon-loaded and preloaded tissue were similar between groups (2.4 vs. 2.2,P= 0.12 and 3.5 vs. 3.3 minutes,P= 0.50). Conclusions: Tissue that is trephinated, stained, and loaded into an injector by the eye bank and then shipped to the surgeon had no difference in clinical outcomes compared with tissue where the surgeon performs these steps. The safety and speed of using preloaded tissue should be considered by DMEK surgeons.