Purpose: To investigate the optimal time for Descemet membrane endothelial keratoplasty (DMEK) graft peeling, and to analyze the rolling properties of endothelial denuded grafts in a rabbit eye model. Materials and Methods: The vertical peeling force required to peel 1 mm wide Descemet membrane (DM) strips, was measured as the change in weight of the system during force application in a rabbit model. Twenty-one rabbit corneoscleral rims were stored in phosphate-buffered saline (PBS) at 4°C, and force analysis was performed at days 1, 5, or 21 after harvesting. After half of the strips of day 5 corneas were peeled and analyzed, the rims were moved to Optisol GS at 4°C, and the remaining strips were peeled off for force analysis at day 10. Separate DM grafts (n = 7) were analyzed by intraoperative optical coherence tomography (OCT) to determine the tissue rolling diameter before and after removal of endothelial cells by a swab. Unpaired t-test was used for statistical analysis. Results: There was a decrease in DM peeling force (p = .008) between days 1 and 5 (556.04 ± 111.76 and 324.30 ± 96.4 mg, respectively), and no difference between days 5 and 21 (p = .53). Peeling force for day 5 corneas placed in Optisol was higher at day 10 (324.30 ± 96.4 to 669.92 ± 166.24 mg, p = .005). The average rolling diameter of DM grafts was similar before and after the removal of endothelial cells (257.9 ± 131.1 and 249.8 ± 126.6 μm, respectively). Conclusions: DMEK Graft procurement could be potentially facilitated by lower DM-stromal adhesion strength at day five after obtaining corneoscleral rims, in a rabbit eye model. Time in the storage medium may influence adhesion strength. Endothelial cells do not appear to play a significant role in the rolling diameter of DM grafts.
Keywords: DMEK; adhesion strength; endothelial keratoplasty; peeling; rolling.