Setting up organ-cultured corneas pre-cutting by a French blood center-eye bank

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Abstract

Purpose

In France, the cutting of endothelial graft for DSAEK is almost exclusively performed by surgeons directly in the operating room whereas in the US more than 2/3 are now precut by eye banks (EB) technicians using 4°C storage. Among the French Blood Center EB, the EB of St-Etienne received the first agreement from the French National Agency for Medicines and Health products for precutting and distribution of corneas. Aim: to report our first experience with DSAEK precut by technicians using organ-cultured (OC) corneas

Methods

OC corneas with an initial endothelial cell density (ECD) >2200 cells/mm2 (by image analysis) were precut by two trained technicians using a Moria microkeratome. Corneas were stored in CMax (Eurobio) and deswelled in CJet (5% Dextran T500) 20h prior to pre-cutting. Central corneal thickness (CCT) was measure by ultrasound before and after cut with a single pass of the 350μm head. Microbiological testing was done with blood culture bottles 24h after precutting

Results

Twelve corneas with initial ECD of 2724±269 cells/mm2 (mean±SD), 19±4 days of OC and CCT of 548±50 μm were cut and sent to 4 centers (Feb to May 2013). Final CCT was 194±33μm (166 to 277). All surgeries were uneventful but rebubbling was necessary in 6 cases and 1 graft with eccentric trephination by the surgeon did never adhere

Conclusion

Precutting of OC corneas by EB allows quality and microbiology controls. Three improvements are ongoing: OCT thickness map before, during and after cut, use of the microkeratome double-pass technique, and ink marking of the centre to guide final trephination by surgeons. Grants: ONDAINE, AOL CHU 2012

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