Viability of preloaded Descemet membrane endothelial keratoplasty grafts with 96-hour shipment

Conan Chen, Steven Jared Solar, John Lohmeier, Staci Terrin, Satya Baliga, Batya Gold Wiener, Daniel Schouten Lewis, Eric Chiang, Kali Alexandra Barnes, Akash Chaurasia, Allen O. Eghrari

Research output: Contribution to journalArticlepeer-review


Objective To assess feasibility and compare the effects of 96-hour shipment of Descemet membrane endothelial keratoplasty (DMEK) grafts as a scroll or a tri-fold on cell viability. Methods and analysis DMEK grafts were prepared at the Rocky Mountain Lions Eye Bank. Twenty pre-stripped DMEK grafts, paired from 10 donors, were either tri-folded in an endothelium-in configuration using microforceps and loaded into a plastic Treyetech cartridge, or suctioned in a scrolled endothelium-out configuration into a modified Jones Tube. Grafts were shipped via FedEx to a secondary location and back for 48 hours each way, resulting in a total shipping time of 96 hours. After shipping, grafts were removed from inserters onto glass slides and unfolded using viscoelastic with endothelium facing upwards. Calcein-AM stained grafts were imaged with a fluorescent microscope and endothelial cell loss (ECL) was measured using trainable segmentation in Fiji by a masked grader. Results A total of 20 grafts were shipped for 96 hours, split between preloaded tri-folded (n=10) and preloaded scrolled (n=10) tissues. No significant difference in ECL was observed across groups after prolonged shipping (14.8% vs 13.7% ECL respectively, p=0.68). Conclusion For preloaded DMEK after 96 hours, both scrolled and tri-folded tissue demonstrated clinically acceptable levels of ECL. The data suggest a wider window of time for endothelial cell viability and is promising for the prospect of international shipment of preloaded grafts.

Original languageEnglish (US)
Article numbere000679
JournalBMJ Open Ophthalmology
Issue number1
StatePublished - May 20 2021


  • DMEK
  • cornea
  • descemet membrane endothelial keratoplasty
  • eye (tissue) banking
  • preloaded
  • trifolded

ASJC Scopus subject areas

  • Ophthalmology


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