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. 2016 Aug 19;100(11):1576–1583. doi: 10.1136/bjophthalmol-2016-308855

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Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Flow diagram outlining the sequence of experimentation. The first experiment comparing storage media showed marked cell overgrowth with enhanced organ culture media making it unsuitable for use in Descemet's membrane endothelial keratoplasty (DMEK) storage. In the second experiment, DMEK grafts were returned to standard organ culture after preparation and were evaluated for features of abnormal cell overgrowth onto the stromal surface of the DM. Peeling and laying back on the stroma was associated with rapid cell overgrowth with endothelial-to-mesenchymal transformation and so was deemed unsuitable as a method for storing DMEK grafts. The other two preparation methods (bubble separation and storage as a free scroll) did not show overgrowth at 4 days post-preparation and global cell density assessment was performed using paired corneas.