Scrolling Behavior of Descemet Membrane Endothelial Keratoplasty Grafts: Analysis of a Large Cohort of 3150 Grafts

PURPOSE: The aim of this study was to analyze the influence of donor characteristics and tissue preservation conditions on the scrolling behavior of grafts in Descemet membrane endothelial keratoplasty (DMEK). METHODS: This retrospective, single-center study included 3150 consecutive DMEK grafts after uneventful preparation for DMEK surgery. The grafts were prepared from either organ-cultured corneoscleral buttons (n = 1414) or corneoscleral buttons stored in Optisol-GS (n = 1736). The main donor characteristics were age, endothelial cell density, death-to-preservation time, preservation method, and storage duration. The thickness of Descemet membrane (DM) was analyzed in a subgroup of 74 grafts using transmission electron microscopy. Scrolling behavior was quantified as roll width using calipers (mm). RESULTS: Older donor grafts exhibited less pronounced scrolling, with a significant correlation between donor age and roll width (r = 0.561, P < 0.001, R2 = 0.308). Organ-cultured grafts exhibited larger roll widths (1.764 ± 0.65 mm) than Optisol-GS-stored grafts (1.516 ± 0.51 mm; P < 0.001). A significant correlation was found between DM thickness and roll width (Spearman ρ = 0.562, P < 0.001, R2 = 0.312), while DM thickness was also significantly correlated with donor age (r = 0.545, P < 0.001, R2 = 0.304). CONCLUSIONS: In this large cohort of DMEK grafts, donor age was confirmed as the most decisive factor influencing the scrolling behavior of DMEK grafts, with younger tissues demonstrating tighter scroll formation while the correlation gradually weakened in older donor groups. The DM thickness was confirmed as an independent contributor, as thicker membranes were associated with less tightly scrolled grafts.