{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T21:57:31Z","timestamp":1791755851804,"version":"4.3.4"},"reference-count":26,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T00:00:00Z","timestamp":1702598400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Ophthalmology"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To report the outcomes of standardizing pre-loaded DMEK with endothelium-inwards and its associated learning curve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between 2017 and 2021, a total of 599 tissues were stripped using \u2018trephine and strip\u2019 method and loaded by folding the tissue as a taco-fold with endothelium-inwards. The folded tissues were pulled inside the funnel of a 2.2\u2005mm IOL cartridge and stored for the desired number of days in organ culture media supplemented with dextran. Donor characteristics, endothelial cell loss (ECL) and mortality assessed by trypan blue positivity before and after stripping, and eventful cases during stripping\/loading were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The tissues found unsuitable for transplant after stripping (6.7%) were significantly higher compared with loading (0.67%). Central or peripheral tears, fragility of the tissues, and insufficient endothelial cell density mainly attributed towards the discard rate. Mean ECL from pre-stripping to post-stripping was 0.27% with endothelial cell mortality of 0.64% at the end of stripping. Cumulative endothelial mortality fold change (pre-strip to post-strip) was high in the first two years of operation (18.9%), which reduced to 5.1% in the following three years with significant difference (p\u2009=\u20090.0352). Average tissue wastage (3 operators) from first 1\u2013150 tissues was 3%, which significantly reduced to 0.9% after achieving the learning curve (151\u2013250) (p\u2009=\u20090.0492).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DMEK graft preparation requires a learning curve. However, an operator with DMEK stripping skills can easily adapt to pre-loading a DMEK graft in endothelium-inwards fashion with minimal learning curve.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11206721231217127","type":"journal-article","created":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T10:06:35Z","timestamp":1702634795000},"page":"1071-1078","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Preloaded DMEK with endo-in technique: Standardizing and minimizing the learning curve over 5 years using 599 corneal tissues"],"prefix":"10.1177","volume":"34","author":[{"given":"Alessandro","family":"Ruzza","sequence":"first","affiliation":[{"name":"International center for ocular physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Grassetto","sequence":"additional","affiliation":[{"name":"International center for ocular physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Favaro","sequence":"additional","affiliation":[{"name":"International center for ocular physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Baruzzo","sequence":"additional","affiliation":[{"name":"International center for ocular physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5148-7643","authenticated-orcid":false,"given":"Vito","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Medical and 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