Feasibility of Descemet membrane endothelial keratoplasty with preloaded and trifolded graft after 96-hour storage and shipping.

Purpose: Descemet membrane endothelial keratoplasty (DMEK) donor grafts can be safely trifolded, preloaded, and shipped for up to 96 hours without significant endothelial cell loss; however, clinical outcomes of such storage times have yet to be reported in human patients. Here we report a case of a trifolded, preloaded DMEK graft stored for 96 hours and transplanted in a 68-year-old female with Fuchs endothelial dystrophy. Methods: The DMEK graft was preloaded and trifolded with post-processing endothelial cell density (ECD) of 2558 cells/mm.2 Intraoperatively, it was pulled into the anterior chamber with 27G irrigating forceps, opened as a sheet, and was positioned without complication using SF6 gas with 80% fill. The graft was attached at all postoperative day visits including day 1, 5, and week 6. Specular microscopy at one week resulted in ECD of 1930 cells/mm2 (endothelial cell loss of 22.8%), and central pachymetry improved from 530 microns preoperatively to 493 at six weeks. Conclusions: We demonstrate feasibility of DMEK with a preloaded and triolded graft stored for 96 hours, with resolution of corneal edema. These results underscore the viability of international shipment and optimized resource distribution of donor tissue where there is a high global need for DMEK grafts.