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Drew Davis, Peter Karth, Christopher Croasdale, Steven Koenig; Tears of post-LASIK corneal donor tissue during surgeon-performed donor graft preparation for DSAEK. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3088. doi: https://doi.org/.
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To describe four cases by two different surgeons in which tears or tissue damage occurred during surgeon-performed preparation of the posterior lamellar corneal lenticule in post-laser assisted in situ keratomileusis (LASIK) corneal donor tissue for Descemet stripping automated endothelial keratoplasty (DSAEK).
In this retrospective case series, all donor corneal tissues had previously undergone LASIK surgery. In all cases, a Moria® artificial anterior chamber maintainer (Moria, Doyleston, PA) and a Moria® ALTK microkeratome (300-um-depth) was used by the surgeon to separate the lamellar corneal tissue.
In all four cases, the post-LASIK corneal donor tissues were torn or damaged during preparation. In two cases, large tears of the posterior lamella occurred during surgeon preparation of the donor lenticule with a microkeratome, and the tissue was deemed unusable. One case was subsequently canceled immediately prior to planned DSAEK; in the second case, an additional donor cornea was available and was successfully transplanted. In the third and fourth cases, the tissue was damaged but was deemed usable. A button-hole perforation occurred in the anterior lamellar cap of the third case, and a linear paracentral ridge was inadvertantly created on the posterior lamella of the donor tissue in the fourth case.
While published literature supports use of post-LASIK donor corneal tissue in DSAEK, we believe that our cases demonstrate a need for caution in surgeon preparation of post-LASIK donor corneal tissue. To avoid tissue waste and cancelled procedures, we recommend post-LASIK donor tissue be prepared in the laboratory prior to the planned procedure. As more potential corneal donors undergo LASIK each year, effective preparation of post-LASIK donor corneal tissue will become an increasingly important consideration.
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