The Influence of Speed During Stripping in Descemet Membrane Endothelial Keratoplasty Tissue Preparation

Purpose: To evaluate whether the speed of stripping a Descemet membrane endothelial keratoplasty graft influences the graft scroll width. Methods: Human corneas suitable for research were selected for the study. Pairs of corneas were randomly divided into 2 groups: 1 cornea was stripped with a slow speed (group 1) and the contralateral with a fast speed (group 2). Slow speed was defined as the total time greater than 150 seconds or speed 0.11 mm/s. The grafts acquired were evaluated by microscopy for the graft scroll width and endothelial cell density change pre- and post-preparation. Results: Twenty corneas of 10 donors were included in the analysis. The mean donor age was 68.6 +/- 7.58 years. The mean total time of the tissue preparation in group 1 was 282.7 +/- 28 seconds and in group 2 was 126 +/- 50 seconds (P-value = 0.00000047). The mean speed of stripping in group 1 was 0.045 +/- 0.006 mm/s and in group 2 was 0.266 +/- 0.093 mm/s (P-value = 0.000027). The graft width in group 1 was 6.4 +/- 0.92 mm and in group 2 was 2.87 +/- 0.32 mm (P-value = 0.00000014). The mean endothelial cell loss in group 1 was 389 +/- 149 cells/mm(2)and in group 2 was 186 +/- 63.44 cells/mm(2)(P-value = 0.00134). Conclusion: We found a correlation between the speed of stripping, scroll width, and endothelial cell loss. Slow-peeled Descemet membrane endothelial keratoplasty grafts result in a wider scroll width but were associated with a greater reduction in endothelial cell density.