Performance outcomes from a DMEK peeling and preparation wet lab.

Parekh, Mohit, Wallace, Alexander George, Airaldi, Matteo, Ruzza, Alessandro, Ferrari, Stefano, Romano, Vito ORCID: 0000-0002-5148-7643 and Ahmad, Sajjad (2024) Performance outcomes from a DMEK peeling and preparation wet lab. BMJ open ophthalmology, 9 (1). e001540-e001540.

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Official URL: http://dx.doi.org/10.1136/bmjophth-2023-001540

Abstract

<h4>Objective</h4>To evaluate the Descemet membrane endothelial keratoplasty (DMEK) preparation performance of trainee surgeons in an ex vivo human donor cornea DMEK wet lab simulation setting.<h4>Methods</h4>Human donor corneoscleral rims unsuitable for transplantation were obtained from Moorfields Lions Eye Bank. At the wet lab, graft stripping was performed by scoring the peripheral endothelium. The trypan blue positive cells (TBPC) and cell density (cells/mm<sup>2</sup>-reticule count) were counted manually before and after stripping. The procedural time, peripheral and central tears and complete peel-off were also recorded and analysed.<h4>Results</h4>Eight trainee surgeons attended the wet lab each attempting three DMEKs. Between the first and last attempts a significant decrease was seen in the procedural time (17.6 min vs 10.6 min (p<0.05)) and the TBPC % (12.9% vs 3.8% (p<0.05)). The percentage of tears peripherally and centrally also reduced between the first and the last trials (50% vs 13% (p=0.2226) and 38% vs 0% (p=0.1327)). A significant correlation was found between longer peeling times and higher TBPC % (p<0.001) with a 0.7% endothelial mortality increase for each additional minute required to complete the peel.<h4>Conclusions</h4>DMEK wet labs provide a controlled risk-free learning opportunity for trainee surgeons to improve confidence and competence. Wet labs improve the success rate of DMEK graft preparation as well as flatten the learning curve. This emphasises the importance of continued support for the expansion of this valuable learning resource, promoting wider uptake of DMEK surgery.

Item Type:	Article
Uncontrolled Keywords:	Cornea, Humans, Trypan Blue, Tissue Donors, Eye Banks, Descemet Stripping Endothelial Keratoplasty, Learning Curve
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	06 Feb 2024 09:39
Last Modified:	06 Feb 2024 09:39
DOI:	10.1136/bmjophth-2023-001540
Open Access URL:	https://bmjophth.bmj.com/content/9/1/e001540
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3178428