Descemet Membrane Endothelial Keratoplasty Using Tissues From Donors With a History of Radial Keratotomy.

PURPOSE: We report 2 successful cases of Descemet Membrane Endothelial Keratoplasty using transplanted tissues from donors with a history of radial keratotomy (RK). METHODS: Four corneas were obtained from 2 donors with a history of RK. After one successful laboratory practice preparation of Descemet Membrane Endothelial Keratoplasty (DMEK) for each patient, 2 additional donor tissues were prepared for DMEK using the established eye bank protocols. RESULTS: Recipient 1 was a 69-year-old female patient who underwent DMEK 6 hours after eye bank preparation of the graft. The postoperative course was uneventful with a clear, attached graft noted at all postoperative visits. The endothelial cell count of the recipient at 7 months was 1953 cells/mm, and the best-corrected distance visual acuity at 1 year was 20/25 + 2. Recipient 2 was a 79-year-old male patient whose DMEK surgery was performed 18 hours after eye bank preparation of the graft. The postoperative course was notable for a re-bubble with air at postoperative day 4 for a peripheral 30% detachment of the donor tissue. No adverse events were noted, with a clear, attached graft at all postoperative visits. A recipient cell count at 6 months showed 2024 cells/mm, and the best-corrected distance visual acuity at 1 year was 20/20. CONCLUSIONS: Two patients received successful DMEK grafts using tissues from donors with a history of RK. Careful eye bank screening and processing of RK donor tissues has thus far yielded similar outcomes in our recipient patients to what would be expected using tissues from donors without a history of RK.

The Utah Protocol for Postmortem Eye Phenotyping and Molecular Biochemical Analysis.

Purpose: Current understanding of local disease pathophysiology in AMD is limited. Analysis of the human disease-affected tissue is most informative, as gene expression, expressed quantitative trait loci, microenvironmental, and epigenetic changes can be tissue, cell type, and location specific. Development of a novel translational treatment and prevention strategies particularly for earlier forms of AMD are needed, although access to human ocular tissue analysis is challenging. We present a standardized protocol to study rapidly processed postmortem donor eyes for molecular biochemical and genomic studies. Methods: We partnered with the Utah Lions Eye Bank to obtain donor human eyes, blood, and vitreous, within 6 hours postmortem. Phenotypic analysis was performed using spectral-domain optical coherence tomography (SD-OCT) and color fundus photography. Macular and extramacular tissues were immediately isolated, and the neural retina and retinal pigment epithelium/choroid from each specimen were separated and preserved. Ocular disease phenotype was analyzed using clinically relevant grading criteria by a group of four ophthalmologists incorporating data from SD-OCT retinal images, fundus photographs, and medical records. Results: The use of multimodal imaging leads to greater resolution of retinal pathology, allowing greater phenotypic rigor for both interobserver phenotype and known clinical diagnoses. Further, our analysis resulted in excellent quality RNA, which demonstrated appropriate tissue segregation. Conclusions: The Utah protocol is a standardized methodology for analysis of disease mechanisms in AMD. It uniquely allows for simultaneous rigorous phenotypic, molecular biochemical, and genomic analysis of both systemic and local tissues. This better enables the development of disease biomarkers and therapeutic interventions.