{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:36:46Z","timestamp":1774485406691,"version":"3.50.1"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T00:00:00Z","timestamp":1747094400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To perform a direct, prospective, comparative analysis of the complications associated with imported preloaded grafts versus surgeon-loaded grafts in Descemet membrane endothelial keratoplasty (DMEK) in Asian eyes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 20 consecutive preloaded DMEKs were matched by donor age with 40 surgeon-loaded DMEKs for the indications of Fuchs\u2019 endothelial cell dystrophy (FECD) and pseudophakic bullous keratopathy (PBK). All cases of preloaded and surgeon-loaded DMEKs were by a single surgeon in the Singapore National Eye Centre and utilized endothelium-in pull-through cartridges (CORONET DMEK Endoglide; Network Medical Products, United Kingdom). Imported preloaded grafts were prepared 72 to 96\u202fh before surgery. The main outcome measures were intra-operative complications such as graft tears, extrusion, and high vitreous pressure. Secondary outcome measures were endothelial cell loss and early post-operative complications such as ocular hypertension, graft detachment, and rebubbling, up to 6\u202fmonths post-operatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Preloaded DMEKs had significantly shorter intra-operative times (26.2\u202fmin vs. 39.5\u202fmin; <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001) than surgeon-loaded DMEKs but were associated with increased intra-operative risk of conversion to standard injector-DMEK (15% vs. 0%; <jats:italic>p<\/jats:italic>\u202f=\u202f0.033). However, there was no increase in overall intra-operative complications (40% vs. 22.5%; <jats:italic>p<\/jats:italic>\u202f=\u202f0.156), early post-operative complications (35% vs. 30%; <jats:italic>p<\/jats:italic>\u202f=\u202f0.772), and rebubbling rate (5% vs. 5%; <jats:italic>p<\/jats:italic>\u202f&amp;gt;\u202f0.999). Visual outcomes and endothelial cell loss were not significantly different in both groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In our Asian study cohort of pull-through DMEKs, endothelium-in preloaded DMEKs were significantly faster than surgeon-loaded DMEKs and had comparable clinical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1580733","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T05:28:59Z","timestamp":1747114139000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical outcomes in imported endothelium-in preloaded vs. surgeon-loaded DMEKs in Asian eyes"],"prefix":"10.3389","volume":"12","author":[{"given":"Ezekiel Ze Ken","family":"Cheong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiu Ying","family":"Wong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard","family":"Cajucom-Uy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hla Myint","family":"Htoon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus","family":"Ang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/s1350-9462(02)00065-4","article-title":"Proliferative capacity of the corneal endothelium","volume":"22","author":"Joyce","year":"2003","journal-title":"Prog Retin Eye Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1038\/sj.eye.6700559","article-title":"Biology of the corneal endothelium in health and 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