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Lily Van Laere, Nirupa Cuttler, Alan Spigelman; The Effect of Donor Graft Thickness in Descemet Stripping Automated Endothelial Keratoplasty Surgery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1563.
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Descemet stripping automated endothelial keratoplasty (DSAEK) has become the favored procedure for patients with endothelial corneal dystrophy, and controversy exists regarding the thickness of the donor endothelial graft and it’s relation to postoperative visual outcomes. We performed a retrospective, observational clinical study to evaluate visual outcomes and complication rates after DSAEK in patients who received precut endothelial grafts of various thicknesses.
We conducted a retrospective chart review of 64 eyes in 49 patients who received DSAEK or combined phacoemulsification/DSAEK at our practice between 2006 and 2013. All procedures were conducted in the same surgical center by a single surgeon, and exclusion criteria included inadequate follow up and presence of co-morbidities or prior surgeries. We collected the following data points: donor endothelial graft thickness measurements provided by the Eye Bank; best spectacle-corrected visual acuity BSCVA pre surgery and at various points post surgery, and any surgical complications.
The eyes were divided in to four groups based on graft thickness: ≤120 μm (10), 121-150 μm (19), 151-180 μm (21), and ≥180 μm (14). Baseline demographics were similar in all groups, and all groups experienced a significant improvement in BSCVA −0.19 ± 0.15 logMAR. Complications included corneal edema (1.6%) and DSAEK dislocation/displacement (4.7%), which resolved with medical/surgical management. There were no significant differences in groups according to donor graft thickness with respect to change in BSCVA or complication rates.
DSAEK is a safe and effective procedure that significantly improves BSCVA in patients with endothelial corneal dystrophy. DSAEK graft thickness does not appear to play an important role in final BSCVA or complication rates, based on the results of this study. Further investigation is needed to further evaluate the ideal graft thickness in DSAEK.
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