DescePrep Significantly Improves the Efficiency of High-Risk Diabetic Donor Descemet Membrane Endothelial Keratoplasty Processing

Purpose: To evaluate Descemet membrane endothelial keratoplasty (DMEK) graft preparation efficiency, success rate, and graft viability after clinically relevant processing of diabetic human donor corneas using DescePrep or submerged cornea using backwards away (SCUBA). Methods: Fifteen pairs of diabetic donor corneas with an average diabetic risk score of 4.0 ± 1.3 and mild–moderate cell loss were processed for DMEK by an experienced certified eye bank technician. Corneas within each pair were randomly assigned to DescePrep or SCUBA and trephined with the number 7 trephine for orientation marking. Donor cornea characteristics, preparation duration, number of graft touches, and success rate were recorded. To simulate clinical graft preparation, DMEK grafts were loaded into a Straiko Modified Jones Tube, shipped, and unscrolled on a glass slide before masked cell viability analysis. Results: We found that 93.3% (14/15) of corneas per group were prepared successfully by DescePrep and by SCUBA. DescePrep significantly reduced overall preparation time from 19.2 ± 0.5 to 15.1 ± 1.1 minutes ( P < 0.005) and significantly reduced stripping time from 10.9 ± 0.5 to 6.97 ± 1.1 minutes ( P < 0.005). Grafts processed by DescePrep and SCUBA demonstrated comparable cell loss of 15.8% ± 1.2% and 16.1% ± 1.4%, respectively, after loading, shipping, and unscrolling. Conclusions: DescePrep offers safe and reliable DMEK graft preparation with high success rates in diabetic tissue. DescePrep reduced preparation time by 21.3% and the number of endothelium contacts by 85.7% in comparison to SCUBA.