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Optimizing the Swelling Reduction Time of Organ Cultured Corneas

Wolf A., Neubauer A. S., Priglinger S., Kampik A., Welge-Lüßen U.,
Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Augenklinik (München)

Introduction: While organculture offers several advantages over cold storage, deswelling is critical to ensure successful transplantation. Corneal thickness similar to the recipients' of approximately 550µm is required. On the other hand deswelling in medium containing Dextran decreases endothelial cell counts and Dextran is absorbed and stored in keratinozytes during deswelling process, thus damaging the organ. Therefore aim of this study was to investigate the minimal deswelling time necessary for a sufficient corneal thickness.
Materials and Methods: A total of 30 human corneas were stored between 13 and 81 days in organ culture (modus 28 days). Central corneal thickness (CCT) was measured by optical coherence tomography (OCT). Measurements were taken before preparation, during culturing, before deswelling and before transplantation. After varying deswelling time of up to 48 hours the final corneal thickness before transplantation was determined. Thus a deswelling characteristics was examined in respect to initial corneal thickness, corneal thickness after storage and storage time.
Results: After organ culture mean CCT was 1180µm. This represents a swelling of approximately 160% as compared to post-mortem values. During deswelling in media containing Dextran CCT rapidly decreased in the first 25 hours in an inverse exponential way. A desireable corneal thickness of 550µm was obtained in mean after 25 hours deswelling. After 30 hours almost no further decrease in CCT was found. No correlation of CCT before preparation and deswelling characteristics was found. However, the longer corneas were kept in organ culture, the more slowly deswelling occured.
Discussion: Corneal thickness is a major factor for the outcome of a corneal transplantation surgery. After 25 hours of deswelling a sufficient corneal thickness for corneal surgery is obtained thus minimizing endothelial cell loss and dextran absorbance of the cornea.