ONLINE EXCLUSIVE
Cornea: Research Highlight
September 2024
by Liz Hillman
Editorial Co-Director
DMEK, as a partial thickness corneal transplant, holds several advantages over full-thickness grafts, but the procedural learning curve is steep. According to Mohit Parekh, PhD, the most training opportunities for DMEK are reserved for those in a cornea fellowship.
But there are foundational learning opportunities that don’t pose a risk to patients, don’t waste valuable tissue, and are available to those at earlier skill levels.
“DMEK training is almost exclusively available only during the cornea fellowship training,” Dr. Parekh said. “Rarely, senior residents may get a chance to perform DMEK almost at the completion of their training. In some instances, a resident with aspirations for cornea fellowship training may be granted partial involvement in DMEK procedures. This opportunity is possible in institutions lacking a dedicated cornea fellowship program, where there is less competition for resident participation, but mostly none. In addition, there are ethical implications regarding trainees’ participation in surgical procedures, contingent upon factors such as their level of training and prior experience in dry or wet labs. Wet labs serve as an optimal environment for resident training, offering a platform where enthusiasm meets educational advancement without jeopardizing patient safety.”
Source: Mohit Parekh, PhD
Dr. Parekh and colleagues recently published objective data on the efficacy of wet lab training for DMEK.1
“It is widely acknowledged that DMEK wet labs play a pivotal role in refining surgical proficiency within controlled ex vivo settings. However, the quantification of the learning trajectory and skill acquisition subsequent to participation in DMEK wet labs remains subjective,” Dr. Parekh said. “It was imperative to systematically monitor this learning process to identify key parameters for potential optimization of several crucial steps that are required for a successful DMEK.”
In the paper, Parekh et al. obtained donor corneoscleral rims that were unsuitable for transplants. The wet lab included eight trainees who performed graft stripping. Trypan blue positive cells and cell density were counted before and after stripping. Procedure time, peripheral and central tears, and complete peel-off were evaluated as well.
According to the paper, each trainee surgeon attempted three DMEKs in the wet lab. The authors recorded a significant decrease in procedural time between the first and last DMEK (17.6 minutes compared to 10.6 minutes). The percentage of tears peripherally and centrally was also reduced between the first and last DMEK preparation in the wet lab. There was a significant correlation between longer peeling times and higher trypan blue positive cell percentage (endothelial mortality increase for each additional minute of peeling was 0.7%).
“Our findings demonstrate that DMEK wet labs serve as crucial learning tools for novice surgeons, fostering both confidence and competence,” Dr. Parekh said. “Participation in these labs correlates with improved success rates in DMEK graft preparation, reduced learning curves, and minimized tissue wastage. Moreover, the risk-free environment provided by wet labs encourages more surgeons to engage in DMEK procedures. Importantly, we have found a greater efficacy of wet lab training in honing surgical skills, decreasing procedural duration, and enhancing overall safety, thereby supporting the advancement and adoption of DMEK surgery for improved patient care. The cultivation of surgeon skills in a safe environment addresses training needs and holds the potential to mitigate wait times and enhance patient safety. Continued support for the expansion of wet lab facilities is imperative to facilitate broader adoption of DMEK surgery and ensure high-quality patient care.”
About the source
Mohit Parekh, PhD
Research Fellow
Massachusetts Eye and Ear Infirmary
Boston, Massachusetts
Reference
- Parekh M, et al. Performance outcomes from a DMEK peeling and preparation wet lab. BMJ Open Ophthalmol. 2024;9:e001540.
Relevant disclosures
Parekh: None
Contact
Parekh: mnparekh@meei.harvard.edu
