Abstract
Purpose:
To investigate the prognosis of corneal endothelium and factors affecting endothelial cell loss post Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) using paired grafts from the same donor to two recipients.
Methods:
Retrospective review of 20 pairs of eyes treated by DSAEK using donor corneal grafts from the same donor. All paired donor grafts were pre-cut and used for DSAEK on the same day by the same surgeon. The pull-through technique using a Busin glide was applied for all cases. The mean patient age was 72.0±9.0 years, and the mean follow-up period was 35 months (range: 12-51 months). The primary diseases were argon laser iridotomy-induced bullous keratopathy (BK) in 17 eyes (42%), Fuchs’ corneal dystrophy in 7 eyes (18%), glaucoma surgery-related BK in 3 eyes (8%), pseudophakic BK in 3 eyes (8%), aphakic BK in 3 eyes (8%), and other disorders in 7 eyes (16%). Patients with surgical complications or graft rejection were excluded from the study. Noncontact specular microscopy (SP-3000; TOMEY Corp., Nagoya, Japan) was used to evaluate corneal endothelium at the central region.
Results:
The mean donor endothelial cell density (ECD) was 3022±134 cells/mm2 (range: 2504-3386 cells/mm2) and the mean difference of ECD in the paired corneas was 4.2% (range: 0-12%). After 1 year postoperative, 12 pairs (Group A; 24 eyes, 60%) showed similar endothelial cell loss and 8 pairs (Group B; 16 eyes, 40%) showed a more than 10% difference of endothelial cell loss. The mean difference of CED in the paired cases in Group A and Group B are 2.9% and 22.1%, respectively. In Group A, 4 paired (33%) showed matching primary diseases. However, in Group B, 7 paired (88%) showed a mismatch of the primary diseases. Six preexisting glaucoma cases in 5 pairs showed accelerated endothelial cell loss.
Conclusions:
Donor endothelial cell viability is essential for the long-term survival of corneal endothelium post DSEAK. However, the primary diseases affect the prognosis of endothelial cell survival and preexisting glaucoma accelerates post-DSAEK endothelial cell loss.
Keywords: 479 cornea: clinical science •
481 cornea: endothelium •
462 clinical (human) or epidemiologic studies: outcomes/complications