Stamping an S on DMEK Donor Tissue to Prevent Upside-Down Grafts: Laboratory Validation and Detailed Preparation Technique Description

Cornea. 2015 Sep;34(9):1175-8. doi: 10.1097/ICO.0000000000000522.


Purpose: To report endothelial cell loss (ECL) caused by a novel S-stamp preparation technique for Descemet membrane endothelial keratoplasty (DMEK).

Methods: Six cadaveric human corneas were prepared for DMEK transplantation using a single standardized technique, including the application of a dry ink gentian violet S-stamp to the stromal side of Descemet membrane. Endothelial cell death was evaluated and quantified using computerized analysis of vital dye staining.

Results: ECL caused by the S-stamp was 0.6% (range 0.1%-1.0%), which comprised less than one-tenth of the total ECL caused by our preparation of the DMEK graft from the start to finish, including recovery, prestripping, S-stamping, and trephination (13.7% total ECL, range 9.9%-17.6%).

Conclusions: Our novel S-stamp donor tissue preparation technique is intuitive to learn and holds the promise of preventing iatrogenic primary graft failure due to upside-down grafts without causing unacceptable increases in ECL.

MeSH terms

  • Coloring Agents / chemistry
  • Corneal Endothelial Cell Loss / diagnosis
  • Descemet Stripping Endothelial Keratoplasty / instrumentation
  • Descemet Stripping Endothelial Keratoplasty / methods*
  • Endothelium, Corneal / pathology
  • Eye Banks / methods
  • Gentian Violet / chemistry
  • Graft Survival*
  • Humans
  • Iatrogenic Disease / prevention & control
  • Intraoperative Complications / prevention & control*
  • Tissue Donors*
  • Tissue and Organ Harvesting / methods*


  • Coloring Agents
  • Gentian Violet