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Mark A. Terry, David Davis-Boozer, Mark Greiner, Asem Alqudah, Michael D. Straiko; Descemet Stripping Automated Endothelial Keratoplasty (DSAEK): Thinner Grafts Do NOT Give Better Vision. Invest. Ophthalmol. Vis. Sci. 2012;53(14):49.
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To determine if pre-operative graft thickness influences visual results after DSAEK in the largest study of this issue ever reported.
DSAEK was performed in 356 eyes with Fuchs’ dystrophy and no ocular comorbidities that would limit visual acuity, (retinal pathology, advanced glaucoma, epithelial irregularities, capsule opacities, etc.). Correlation analysis of pre-operative graft thickness (measured by OCT) and best corrected visual acuity (BCVA) at 6 months was performed. The thickness of the transplanted donor tissue was also considered as a proportion of the total thickness of the donor cornea, and this "percent thickness" was also analyzed for correlation with 6-month BCVA. In addition, BCVA from grafts thicker than 130 microns were compared to BCVA from grafts thinner than 130 microns by students t-test.
Graft thickness ranged between 80 to 200 microns, with the transplanted lenticule representing a mean percent thickness of the donor of 31.8% (range = 21% to 40%). Mean BCVA at 6 months post-op was 20/28 (Range: 20/16 to 20/60). There was no significant correlation between graft thickness and post-op visual acuity (Pearson = 0.081; p = 0.164) in the thickness range between 100 and 200 microns. There also was no correlation between the lenticule as a percent of overall donor thickness and post-op visual acuity (Pearson = 0.043; p = 0.466). Grafts thicker than 130 um (n=314) yielded mean BCVA of 20/28, with 21% 20/20 or better. Grafts thinner than 130 um (n=42) yielded mean BCVA of 20/26 with 24% 20/20 or better. There was no significant difference in mean vision (p=.077) or in percent with 20/20 or better (p=.687) between groups.
Excellent vision can be obtained with grafts 200 microns and thinner and no correlation can be found between pre-operative graft thickness and visual results. Special requests from eye banks for "thin" or "ultra-thin" tissue may not be justified.
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