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Michael L. Bullard, Maria A. Woodward, Roni M. Shtein; Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) Dislocation Rates and Preoperative Donor Tissue Characteristics. Invest. Ophthalmol. Vis. Sci. 2012;53(14):41.
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© ARVO (1962-2015); The Authors (2016-present)
To determine whether pre-cut donor corneal tissue characteristics have an effect on DSAEK dislocation rates
Pre- and post-operative data were obtained retrospectively on consecutive DSAEK procedures performed from 2007 to 2011 by six surgeons at one institution using eye bank pre-cut donor corneas. Data collected included: time of death to tissue processing (D-to-P), time of tissue processing to surgery (P-to-S), preoperative endothelial cell density (ECD), change in pre- versus post-cut endothelial cell density, and preoperative graft thickness. The primary outcome was graft dislocation. Statistical analysis was performed using two-tailed t-tests and Chi square analysis.
Threehundred fifty-five patients underwent DSAEK; 57% were women and 43% men. Indications for surgery were Fuchs dystrophy(81%), pseudophakic bullous keratopathy (16%) or other diagnoses (3%). Therewere 64 dislocation events(18%). The mean D-to-P, mean P-to-S, mean preoperative ECD, mean change in pre- to post-cut ECD, and mean preoperative graft thickness were not significantly different between the two groups (p=.348, p=.203, p=.989, p=.154, and p=.481, respectively). The only variable that was statistically significantly different between the two groups was recipient age (p=0.02; mean age 70.2 in the no dislocation group and 73.6 in the dislocation group). The patients’ gender, preoperative diagnosis, and visually-limiting ocular comorbidities were not associated with the occurrence of dislocation (p=.555, p=.547, and p=.770, respectively). Graft dislocation did not impact the patients’ logMAR visual acuity at 1 year or at the last visit (p=.184, p=.279, respectively).
Pre-cut donor cornea tissue characteristics did not have a significant effect on dislocation rates after DSAEK. Older recipients were more likely to experience graft dislocation. The likelihood of dislocation may be more affected by differences in recipient characteristics or surgical technique, rather than donor corneal tissue characteristics.
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