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Michael D. Straiko, Mark A. Terry, Mark Greiner, Asem Qudah, David Davis-Boozer, Josh Galloway, Chris Stoeger; Dsaek: Does Increasing The Storage Time From The Pre-cutting Of Donors To The Date Of Transplantation Cause Higher Complication Rates Or Cell Loss?. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3133.
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To determine if the time from pre-cutting tissue with a microkeratome in the Eye Bank to transplantation days later in surgery affects complication rates or donor endothelial survival.
485 DSAEK cases were performed at Devers Eye Institute in Portland, OR for Fuchs’ dystrophy eyes without prior glaucoma surgery. The time from microkeratome cutting to transplantation was recorded for each case. Complications and central endothelial cell densities (ECD) at 6 months were recorded and correlation analysis done. Groups with storage time of less than 1 day (n=58), 1 day (n=334), 2 days (n=84) and greater than 2 days (n=9) were compared for complications and post-op % ECD loss.In a separate analysis, 39 corneas we pre-cut in Portland and then shipped to Europe for DSAEK in patients with various diagnoses. Cut-to-transplant interval ranged from 3 to 9 days. Post-operative ECD was unavailable for this group, but rates of post-operative complications are reported.
There was no significant correlation between percentage ECD loss and time between pre-cutting and use (Pearson Corr. Coeff.=0.069, p=0.148). The mean % ECD loss was 24.3%, 21.2%, 26.7% and 26.4% for tissues stored less than1 day, 1 day, 2 days and greater than 2 days. There were 2 dislocations in the less than 1 day group (3%), 2 dislocations in the 1 day group (6%) and the 5 dislocations in the 2 day group (6%). There were no primary graft failures in the study population.Among the tissue shipped to Europe, there was one post-operative dislocation and no primary graft failures. The tissue that dislocated had a cut-to-transplant interval of 8 days.
The complication rate and the endothelial cell loss at 6 months after DSAEK surgery is similar whether the tissue is cut immediately before use or stored after cutting for at least 2 days. Surgeons can feel comfortable accepting tissue which is cut at least 2 days before use.While the data on internationally shipped tissue is less powerful, it does suggest that longer storage times are acceptable for safe DSAEK, and more data is needed to fully answer that question.
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