{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:01:47Z","timestamp":1787022107218,"version":"build-2736575974"},"reference-count":62,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T00:00:00Z","timestamp":1656547200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We investigated whether (1) imported pre-cut tissue is feasible for Descemet membrane endothelial keratoplasty (DMEK) in eyes of Asian patients, (2) the clinical outcome is comparable between the endothelium\u2010in and endothelium\u2010out methods, and (3) the corneal edema-induced anterior curvature changes may have an effect on the refractive error.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The medical records of 32 DMEK patients who underwent either the endothelium-out or endothelium-in method using imported pre-cut grafts with a 3-day pre-cut-to-use time were retrospectively analyzed. Fuchs\u2019 endothelial dystrophy (37.5%) and bullous keratopathy (62.5%) cases were included. The main clinical outcome measures were graft survival, best corrected visual acuity (BCVA), endothelial cell density (ECD), corneal thickness (CT), and complications. Correlation of the anterior curvature changes with refractive error was analyzed in the DMEK with cataract surgery group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall survival rate was 71.9%. Final graft failures were caused by rejection, glaucoma, and infection. Visual acuities improved by 89.3%. BCVA better than 20\/40 and 20\/20 was found in 75% and 28.6% of patients, respectively. The ECDs at 3 months and 1 year were 1400 and 1083 cells\/mm\n                      <jats:sup>2<\/jats:sup>\n                      , respectively. The mean survival time, ECD, BCVA, CT, and complication rates were not different between the endothelium-in and endothelium-out methods. A hyperopic shift by +0.42 D was not related to the anterior curvature changes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Imported pre-cut tissues with a \u2264 3-day pre-cut-to-use time are feasible for DMEK in the treatment of corneal endothelial edema in eyes of Asian patients, and both endothelium-in and endothelium-out methods appear to be comparatively effective. Edema-induced anterior curvature change may not affect the refractive shift.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0270037","type":"journal-article","created":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T13:39:57Z","timestamp":1656596397000},"page":"e0270037","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) with imported donor corneas in eyes of Asian patients; endothelium\u2010in versus endothelium\u2010out method"],"prefix":"10.1371","volume":"17","author":[{"given":"Young-ho","family":"Jung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Ho","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7850-6894","authenticated-orcid":true,"given":"Mee Kum","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,6,30]]},"reference":[{"issue":"6","key":"pone.0270037.ref001","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1097\/00003226-199811000-00010","article-title":"A surgical technique for posterior lamellar keratoplasty","volume":"17","author":"GR Melles","year":"1998","journal-title":"Cornea"},{"key":"pone.0270037.ref002","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1146\/annurev-vision-102016-061400","article-title":"EK (DLEK, DSEK, DMEK): New Frontier in Cornea Surgery.","volume":"3","author":"MO Price","year":"2017","journal-title":"Annu Rev Vis 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Melles","year":"2006","journal-title":"Cornea"},{"issue":"8","key":"pone.0270037.ref006","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1097\/01.ico.0000243962.60392.4f","article-title":"Posterior lamellar keratoplasty: DLEK to DSEK to DMEK","volume":"25","author":"GR Melles","year":"2006","journal-title":"Cornea"},{"key":"pone.0270037.ref007","first-page":"CD012097","article-title":"Descemet\u2019s membrane endothelial keratoplasty (DMEK) versus Descemet\u2019s stripping automated endothelial keratoplasty (DSAEK) for corneal endothelial failure.","volume":"6","author":"AJ Stuart","year":"2018","journal-title":"Cochrane Database Syst Rev."},{"issue":"3","key":"pone.0270037.ref008","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/ICO.0000000000001093","article-title":"Techniques for Learning Descemet Membrane Endothelial Keratoplasty for Eyes of Asian Patients With Shallow Anterior Chamber","volume":"36","author":"T Hayashi","year":"2017","journal-title":"Cornea"},{"issue":"8","key":"pone.0270037.ref009","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1097\/ICO.0000000000002302","article-title":"Descemet Membrane Endothelial Keratoplasty in Asian Eyes: Intraoperative and Postoperative Complications","volume":"39","author":"M Ang","year":"2020","journal-title":"Cornea"},{"issue":"3","key":"pone.0270037.ref010","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1038\/s41433-019-0497-9","article-title":"Fuchs endothelial corneal dystrophy and corneal endothelial diseases: East meets West.","volume":"34","author":"YQ Soh","year":"2020","journal-title":"Eye (Lond)."},{"issue":"9","key":"pone.0270037.ref011","doi-asserted-by":"crossref","first-page":"6959","DOI":"10.1167\/iovs.11-7771","article-title":"Prevalence of corneal dystrophies in the United States: estimates from claims data","volume":"52","author":"DC Musch","year":"2011","journal-title":"Invest Ophthalmol Vis 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Busin","year":"2016","journal-title":"Ophthalmology"},{"key":"pone.0270037.ref015","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.ajo.2020.07.004","article-title":"Three-Year Outcomes of Tri-Folded Endothelium-In Descemet Membrane Endothelial Keratoplasty With Pull-Through Technique","volume":"219","author":"AC Yu","year":"2020","journal-title":"Am J Ophthalmol"},{"issue":"5","key":"pone.0270037.ref016","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1097\/ICO.0000000000002268","article-title":"Descemet Membrane Endothelial Keratoplasty With a Pull-Through Insertion Device: Surgical Technique, Endothelial Cell Loss, and Early Clinical Results","volume":"39","author":"TE Tan","year":"2020","journal-title":"Cornea"},{"issue":"9","key":"pone.0270037.ref017","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1097\/ICO.0000000000001650","article-title":"Endothelium-in Versus Endothelium-out Insertion With Descemet Membrane Endothelial 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Bae","year":"2020","journal-title":"J Refract Surg"},{"key":"pone.0270037.ref021","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.2147\/OPTH.S136882","article-title":"Predicting the refractive outcome and accuracy of IOL power calculation after phacoemulsification using the SRK\/T formula with ultrasound biometry in medium axial lengths.","volume":"11","author":"Y Karabela","year":"2017","journal-title":"Clin Ophthalmol."},{"issue":"2","key":"pone.0270037.ref022","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1177\/1120672118785282","article-title":"Can we predict the refractive outcome after triple Descemet membrane endothelial keratoplasty?","volume":"29","author":"VA Augustin","year":"2019","journal-title":"Eur J Ophthalmol"},{"key":"pone.0270037.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajo.2018.08.052","article-title":"Avoiding Hyperopic Surprises After Descemet Membrane Endothelial Keratoplasty in Fuchs Dystrophy Eyes by Assessing Corneal Shape","volume":"197","author":"M Fritz","year":"2019","journal-title":"Am J Ophthalmol"},{"issue":"11","key":"pone.0270037.ref024","doi-asserted-by":"crossref","first-page":"2036","DOI":"10.1001\/archopht.1978.03910060424004","article-title":"Corneal endothelial dystrophy. A study of 64 families","volume":"96","author":"JH Krachmer","year":"1978","journal-title":"Arch Ophthalmol"},{"issue":"4","key":"pone.0270037.ref025","first-page":"687","article-title":"Fuchs\u2019 endothelial corneal dystrophy: subjective grading versus objective grading based on the central-to-peripheral thickness ratio","volume":"120","author":"DJ Repp","year":"2013","journal-title":"Ophthalmology"},{"issue":"4","key":"pone.0270037.ref026","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/ICU.0000000000000060","article-title":"Eye-bank preparation of endothelial tissue.","volume":"25","author":"GE Boynton","year":"2014","journal-title":"Curr Opin Ophthalmol"},{"issue":"5","key":"pone.0270037.ref027","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/ICO.0000000000000394","article-title":"Evaluation of a new technique for preparation of endothelial grafts for descemet membrane endothelial keratoplasty","volume":"34","author":"A Brissette","year":"2015","journal-title":"Cornea"},{"issue":"3","key":"pone.0270037.ref028","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/ICO.0000000000000045","article-title":"Descemet membrane endothelial keratoplasty donor preparation: navigating challenges and improving efficiency","volume":"33","author":"LR Tenkman","year":"2014","journal-title":"Cornea"},{"key":"pone.0270037.ref029","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.2147\/OPTH.S170263","article-title":"A 10-year review of underlying diseases for endothelial keratoplasty (DSAEK\/DMEK) in a tertiary referral hospital in Japan.","volume":"12","author":"T Nishino","year":"2018","journal-title":"Clin Ophthalmol"},{"key":"pone.0270037.ref030","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.ajo.2019.10.017","article-title":"Parameters Associated With Endothelial Cell Density Variability After Descemet Membrane Endothelial Keratoplasty","volume":"211","author":"S Oellerich","year":"2020","journal-title":"Am J Ophthalmol"},{"issue":"4","key":"pone.0270037.ref031","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.ajo.2009.04.025","article-title":"Endothelial cell density after descemet membrane endothelial keratoplasty: 1- to 2-year follow-up","volume":"148","author":"L Ham","year":"2009","journal-title":"Am J Ophthalmol"},{"key":"pone.0270037.ref032","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ajo.2020.04.005","article-title":"Descemet Membrane Endothelial Keratoplasty: Ten-Year Graft Survival and Clinical Outcomes","volume":"217","author":"I Vasiliauskait\u0117","year":"2020","journal-title":"Am J Ophthalmol"},{"issue":"10","key":"pone.0270037.ref033","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1038\/s41433-018-0152-x","article-title":"Descemet\u2019s membrane endothelial keratoplasty: surgical outcomes and endothelial cell count modelling from a UK centre","volume":"32","author":"MAP Fajgenbaum","year":"2018","journal-title":"Eye (Lond)."},{"key":"pone.0270037.ref034","article-title":"Long-Term Outcome of Descemet Membrane Endothelial Keratoplasty in Eyes With Fuchs Endothelial Corneal Dystrophy Versus Pseudophakic Bullous Keratopathy","author":"SB Zwingelberg","year":"2021","journal-title":"Cornea"},{"key":"pone.0270037.ref035","doi-asserted-by":"crossref","unstructured":"Kim M. Current Progress in corneal Xenotransplantation In Xenotransplantation NEW INSIGHTS 2017 1st Ed. INTECH. Editor Shuji Miyagawa 25\u201346","DOI":"10.5772\/intechopen.69144"},{"key":"pone.0270037.ref036","doi-asserted-by":"crossref","first-page":"2239","DOI":"10.2147\/OPTH.S310873","article-title":"Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand.","volume":"15","author":"K Lekhanont","year":"2021","journal-title":"Clin Ophthalmol."},{"key":"pone.0270037.ref037","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ajo.2016.08.023","article-title":"Descemet Membrane Endothelial Keratoplasty: Preliminary Results of a Donor Insertion Pull-through Technique Using a Donor Mat Device","volume":"171","author":"M Ang","year":"2016","journal-title":"Am J Ophthalmol"},{"issue":"1","key":"pone.0270037.ref038","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12886-017-0436-0","article-title":"Outcomes of descemet stripping automated endothelial keratoplasty using imported donor corneas.","volume":"17","author":"K Lekhanont","year":"2017","journal-title":"BMC Ophthalmol."},{"key":"pone.0270037.ref039","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.ajo.2020.10.014","article-title":"Long-Term Review of Penetrating Keratoplasty: A 20-Year Review in Asian Eyes","volume":"224","author":"A Anshu","year":"2021","journal-title":"Am J Ophthalmol"},{"issue":"2","key":"pone.0270037.ref040","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1111\/aos.13162","article-title":"Endothelium-in versus endothelium-out for Descemet membrane endothelial keratoplasty graft preparation and implantation.","volume":"95","author":"M Parekh","year":"2017","journal-title":"Acta Ophthalmol"},{"issue":"3","key":"pone.0270037.ref041","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/ICO.0000000000001831","article-title":"Comparison of Tri-folded and Scroll-based Graft Viability in Preloaded Descemet Membrane Endothelial Keratoplasty","volume":"38","author":"K Barnes","year":"2019","journal-title":"Cornea"},{"issue":"3","key":"pone.0270037.ref042","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1097\/ICO.0000000000002194","article-title":"Quantitative and Qualitative Differences in Endothelial Cell Loss Between Endothelium-In Versus Endothelium-Out Loading in Descemet Membrane Endothelial Keratoplasty","volume":"39","author":"J Ho","year":"2020","journal-title":"Cornea"},{"issue":"5","key":"pone.0270037.ref043","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1097\/ICO.0000000000002648","article-title":"Techniques, Outcomes, and Complications of Preloaded, Trifolded Descemet Membrane Endothelial Keratoplasty Using the DMEK EndoGlide","volume":"40","author":"M Ighani","year":"2021","journal-title":"Cornea"},{"key":"pone.0270037.ref044","article-title":"Aspiration of Tri-folded, Endothelium-In Grafts for Descemet Membrane Endothelial Keratoplasty","author":"S Karakus","year":"2019","journal-title":"Cornea"},{"issue":"12","key":"pone.0270037.ref045","first-page":"2361","article-title":"Descemet\u2019s membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival","volume":"116","author":"MO Price","year":"2009","journal-title":"Ophthalmology"},{"issue":"5","key":"pone.0270037.ref046","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1016\/j.ajo.2011.10.003","article-title":"Causes of glaucoma after descemet membrane endothelial keratoplasty","volume":"153","author":"M Naveiras","year":"2012","journal-title":"Am J Ophthalmol"},{"issue":"11","key":"pone.0270037.ref047","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1016\/j.ophtha.2011.03.037","article-title":"Learning Curve in Descemet\u2019s Membrane Endothelial Keratoplasty: First Series of 135 Consecutive Cases.","volume":"118","author":"I Dapena","year":"2011","journal-title":"Ophthalmology"},{"key":"pone.0270037.ref048","article-title":"\"PI-less DMEK\": results of Descemet\u2019s membrane endothelial keratoplasty (DMEK) without a peripheral iridotomy.","author":"E Livny","year":"2018","journal-title":"Eye (Lond)."},{"issue":"11","key":"pone.0270037.ref049","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1038\/sj.eye.6702974","article-title":"Injecting an air bubble at the end of sutureless cataract surgery to prevent inflow of ocular surface fluid","volume":"21","author":"DA Sim","year":"2007","journal-title":"Eye (Lond)."},{"key":"pone.0270037.ref050","doi-asserted-by":"crossref","first-page":"696302","DOI":"10.1155\/2014\/696302","article-title":"The injection of air\/oxygen bubble into the anterior chamber of rabbits as a treatment for hyphema in patients with sickle cell disease","volume":"2014","author":"E Ayintap","year":"2014","journal-title":"J 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