Lions World Vision Institute · TransplantREADY®
A low-touch path from donor to anterior chamber, preloaded endothelium-in, cut by a technique that is both gentler and more precise — plus the only sterile asymmetrical CAIRS in the field. Below: how the tissue is prepared, the outcomes behind it, and the full range of grafts available for your cases.
The low-touch path
Fewer touches. More cells.
Every time a graft is handled, endothelial cells are lost — and those cells never come back. Lions World Vision Institute built its entire preparation and delivery process around one idea: touch the tissue as few times as possible, from recovery to the moment it enters the eye.
Since 1969 that work has restored sight to more than 500,000 people worldwide, and today reaches over 20,000 men, women and children every year living with corneal blindness or low vision. LWVI now distributes more than 25,000 ocular tissues a year to roughly 950 surgeons across 46 states and 70 countries. That scale is what makes the preparation methods below repeatable rather than exceptional.
Prepared to your spec
Predissected, prestained, premarked and prepunched to the parameters on your account.
Preloaded and oriented
Tri-folded endothelium-in and locked in orientation before the tissue leaves the lab.
Documented preservation
Published comparisons on cell loss, recovery time and graft thickness — not claims.
Ready when you are
Register once and every graft after that arrives to the same specification.
Cell loss is cumulative. So is every reduction.
Most endothelial loss happens before the transplant — during dissection, staining, loading and insertion. Each stage below reduces the handling at one of them.
Blister hydrodissection
Fluid, not forceps, separates Descemet's membrane. The graft is never manually stripped, so the endothelium is never grasped.
No forceps contactSelective stromal staining
Dissection and staining happen in one motion, marking only the stromal side. The endothelium is never bathed in Trypan Blue.
10× less loss vs. SCUBA†Tri-folded endo-in
A proprietary tri-fold secures the graft endothelium-in, held by a permeable sponge. Orientation is fixed in the lab.
Orientation set before the ORFluid-pulse insertion
Pulses of fluid carry the graft in already oriented. Endo-in geometry lets it unscroll itself returning to endo-out.
3× less loss vs. pull-through5What the graft avoids
- Manual stripping of Descemet's with forceps
- Three minutes of endothelial exposure to Trypan Blue
- Six graft-manipulating steps during dissection and staining
- Pull-through endoserters dragging tissue through a cartridge
- Intraoperative loading
- External tapping to unscroll the graft
What arrives instead
- Hydrodissected graft, stroma-side stained only
- Prepunched to your diameter, premarked "S" or "I-II"
- Tri-folded endo-in, secured by permeable sponge
- Orientation maintained through transport
- Closed system that keeps the chamber deep and stable
- No viscoelastic and no AC maintainer required
What that means for the cornea you implant
Cell loss is measured as a percentage, but the surgeon inherits it as endothelial cell density. Starting from the same 2,500 ECD donor cornea, the preparation method alone accounts for a difference of roughly 450 cells.
- SCUBA dissection and staining — 20.1% loss → implanted at 2,000 ECD
- LWVI Blister hydrodissection — 2.2% loss → implanted at 2,450 ECD
Endothelial cell damage by Image J analysis.†
"It makes DMEK into a predictable procedure with less trauma to endothelial cells."
Benjamin Lambright, MD · West Coast Eye InstituteDocumented outcomes
One technique. Two things it buys you.
The High-Pressure Anterior Chamber (HPAC) technique, developed at LWVI in 2012, holds the cornea well above standard eye bank pressures during preparation. A proprietary nomogram sets the calibration from cutting depth, donor age and stromal hydration. Limiting edema and folds before the microkeratome pass does two separate things: it stresses the endothelium less, and it makes the depth of the cut far more predictable.
1 · Gentler on the endothelium
Cell damage post-processing
About 4× less cell loss than standard anterior chamber pressure.4
Endothelial recovery time
Cells recover roughly 10× faster with HPAC.4
2 · More predictable thickness
A gentler cut is only half the value. Because the cornea sits stable and unfolded under high pressure, the microkeratome reaches its target depth consistently — which is what makes a reliable ultrathin DSAEK graft possible in the first place.
Grafts achieving central thickness under 100 µm
Targeting under 70 µm, HPAC succeeds 81.6% of the time.1,3
Why thickness predictability matters
- Consistent 40–70 µm grafts, case after case
- Stromal bed 1–1.5 mm wider than standard pressure methods
- Lower processing failure rate, so fewer replacement corneas
This is the preparation behind the ultrathin DSAEK graft in the next section — and behind OptiGraft CAIRS further down.
Preloaded in a Weiss Glass Cannula
Two grafts. One low-touch delivery.
Both are prepared with the techniques above and preloaded endothelium-in, so the graft is handled less in the lab and again less in the OR. Both are patent pending.
Endo-In DMEK
Fluid injection · endo-inPreloaded with the endothelium inside the scroll. Introduced slowly into the AC, it opens on its own trying to return to endo-out — entering oriented correctly and unscrolling without external tapping. Conventional endo-out delivery, by contrast, means a flat chamber, tapping techniques to master, and host stroma or iris contact that costs cells.
Spec sheetPreassembled system
- Delivered through a 3.0–3.2 mm incision
- Average 4% endothelial cell loss
- 2.6 mm Weiss Glass Cannula outer diameter
- 14 Fr tubing and end-cap luer lock, connecting directly to a luer lock syringe
- Permeable sponge and protective silicone tip secure the graft in transit
- Maintains orientation during transport; no AC maintainer required
Ultrathin DSAEK
Fluid injection · endo-inCut with the HPAC technique to a consistent 40–70 µm, then secured endothelial-side-in by proprietary trifold loading so orientation holds through transport. Fluid injection through a closed system keeps the chamber deep and stable and promotes a natural fluid-assisted unfolding of the graft.
Spec sheetKey features
- Delivered through a 3.5 mm incision
- Less than 6% endothelial cell loss
- 2.8 mm diameter delivery system
- 40–70 µm consistent graft thickness
- Closed system deepens the chamber; no viscoelastic required
- Eliminates the need for punch, forceps and AC maintainer
OptiGraft® CAIRS
Reshape the cone with tissue, not plastic.
Sterile, femtosecond laser-cut allogenic ring segments for keratoconus and other ectatic disorders. Because the segment is donor stroma, it integrates with the host cornea and avoids the extrusion and melt risk of synthetic rings.
Only at LWVI: sterile laser-cut asymmetrical CAIRS, stored at room temperature for up to two years.
Laser precision
Cut on the Ziemer Z8 femtosecond laser to a uniform 550 µm depth, in geometries tailored to irregular topography rather than fixed stock sizes.
Asymmetrical
Variable profiles match the flattening effect to a decentered cone instead of uniform thickness across the arc.
Terminally sterile
Electron beam irradiated to a Sterility Assurance Level of 10-6, hydrated in human serum albumin. Drying prior to placement is optional.
Shelf-stable
Two-year room temperature storage — segments sit on your shelf, ready when the case is, with no cold chain and no waiting on tissue.
Why laser-cut beats hand-cut
A manually prepared segment carries the donor cornea's edema with it. Measured by OCT, hand-cut CAIRS have run 530 µm on one side and 990 µm on the other, and when two separate donor punches are used the widths may not match at all.
OptiGraft segments begin with the same HPAC preparation used for ultrathin DSAEK — restoring the cornea to near-physiologic hydration and eliminating variable edema — before the laser ever cuts.
Available geometries
- Concentric arcs — 0.5, 0.75, 1.0, 1.5, 2.0 mm
- Asymmetrical crescent arcs — 1.5, 2.0 mm width
- Asymmetrical tapered arcs — 1.5, 2.0 mm width
All cut from full-thickness cornea to 550 µm. Bowman's membrane grafts available to the same specification.
Dr. Soosan Jacob, who developed CAIRS in 2015, consults to the OptiGraft program and leads our wet labs at ESCRS and AAO. A dedicated Rumex CAIRS instrument set is available — use code LWVI10 when ordering for a 10% discount. Free segment planning is available at CAIRSPlan.com. For on-site training, email contact@LWVI.org.
Also available
The rest of the portfolio.
Advanced cornea processing
DMEK, DSAEK, ALK/DALK and PKP — predissected, prestained, premarked or prepunched to your registered parameters.
Processing detailPre-punched PK
Punched to your requested diameter with a 1 mm bridge securing the graft in transit. The service includes the recipient trephine, so the ASC stops stocking every size.
Pre-punched PKSterile tissue & BrightMEM
OptiGraft sterile cornea and sclera for glaucoma tube coverage and reconstruction, plus patch grafts, Bowman's membrane and Dua's layer.
Sterile optionsLions World Vision Institute
1410 N. 21st St., Tampa, FL 33605
(813) 289-1200
cornea@lwvi.org
Seattle
1200 6th Ave, Suite 310
Seattle, WA 98101
(800) 214-6356
Sightlink
Commercial partner
(512) 655-9025
contact@sightlinkus.com
1. Abdullayev E, Moore D, Kurz A. ASCRS Symposium & Congress, April 2022. 2. Abdullayev E, Desai N, Miller C. EBAA Scientific Symposium, June 2012. 3. Clerici R, et al. Cornea. 2021;40(6):755–763. 4. Abdullayev E, Talbot K, Gray M, Sprehe N. ASCRS Symposium & Congress, May 2019. 5. Miles J, University of Florida Department of Ophthalmology. Mean endothelial cell loss: 2.8 mm Weiss Glass Cannula 7.7% through a 3.4 mm wound (n=5); DSAEK forceps 23.1% through a 4.0 mm wound (n=5); Busin glide 24.7% through a 4.0 mm wound (n=10). † Endothelial cell damage by Image J analysis: LWVI Blister technique 2.2% versus SCUBA dissection and staining 20.1%. The Weiss Glass Cannula is a Class 1 medical device (HMX) manufactured by Gunther Weiss Scientific Glassblowing, Inc. Endo-In DMEK and TransplantREADY UT-DSAEK patent pending. OptiGraft® and TransplantREADY® are registered marks of Lions World Vision Institute.