Endothelial cell loss using different graft injectors in DMEK
Reviewed by Magdalena Popiela

This study aimed to investigate endothelial cell loss between two injector systems in descemet membrane endothelial keratoplasty (DMEK) grafts; a glass injector – modified Jones tube and a plastic injector – closed system IOL injector, the Viscoject 2.2 system. DMEK grafts were prepared in a standardised way, mimicking steps in routine DMEK surgery. All grafts were imaged with specular microscopy before and after peeling. They were kept in Optisol and stored overnight before cutting, staining and loading into the two different injector systems according to the routine surgical technique. Grafts were then injected into the viscoelastic bed before further imaging. Grafts injected with Viscoject had average cell loss of 32%, ones injected with modified Jones tube – 27%, with no significant difference between them. The slightly higher endothelial cell loss compared to the one previously reported by same authors using the same peeling method has been attributed to the extra handling before injector loading. This study does not support the use of one injector over the other, allowing surgeons to use their personal preference in choosing the graft injectors for DMEK. 

Quantification and patterns of endothelial cell loss due to eye bank preparation and injector method in descemet membrane endothelial keratoplasty tissues.
Schallhorn J, Holiman J, Stoeger C, et al.
CORNEA
2016;35(3):377-82.