Eyeworld

23 EW NEWS & OPINION November 2018 faster with the preloaded tissue," he said, adding that it was about half the unscrolling time as seen previ- ously. Perhaps having the trypan blue on the tissue for a day or two makes the tissue a little stiffer and allows it to unscroll easier, he theo- rized. From a clinical perspective, Dr. Terry views the use of the preloaded tissue as safer than when the sur- geon performs all the steps. Also, it saves time in the OR as well as mon- ey, he pointed out. "Our operating room charges about $70 a minute," he said. "Any time you can save will also save money and will allow better efficiency." He estimated that using preloaded tissue saves about 15 minutes per case, something that will enable more procedures to be done each day, Dr. Terry noted. The practice also saves money since there is no need to purchase trypan blue, trephines that cost hun- dreds of dollars, or Straiko injectors, he continued, adding that although the processing fee for the preload- ed tissue is greater than traditional tissue, this does not cost the practice more since it is a Medicare pass- through expense. One pearl for those who opt for the preloaded tissue is to be aware that eye banks will trephinate the tissue to whatever size the practi- tioner dictates, Dr. Terry explained. If no size is dictated, however, then the eye bank will automatically send an 8 mm stripped area. "In 99% of my cases, I do an 8 mm stripped area, but occasionally I'll have a small eye and I'll need a 7 mm stripped area," he said. "So I have to tell the eye bank in advance that this is what I need." Overall, Dr Terry hopes that practitioners come away from the study with the understanding that DMEK surgery has now evolved to the point where many surgeons can incorporate this. "Finally, DMEK is at a point where it is faster, easier, and safer than it has ever been," he said. "Any surgeon who does endo- thelial keratoplasty should be able to learn how to do DMEK surgery now that these other problems are taken care of." EW Contact information Terry: mterry@deversseye.org Reference 1. Newman LR, et al. Preloaded Descemet membrane endothelial keratoplasty donor tissue: surgical technique and early clinical results. Cornea. 2018;37:981–986. Editors' note: Dr. Terry has no financial interests related to his comments. 840 Walnut St., Philadelphia, PA 19107 | willseye.org | 877.289.4557 Alex V. Levin, MD, MHSc, FRCSC Chief, Pediatric Ophthalmology and Ocular Genetics *Based on a Doximity clinical reputation survey for 2018-2019. When conquering eye disease demands resolve, we embrace the long and difficult road. That's part of the reason so many residents want to come to Wills Eye Hospital to train. We teach perseverance. Voted #1 ophthalmology residency program in the United States.* Where no challenge is too great.

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