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L. J. Wendel, M. D. Wagoner, K. M. Goins; Endothelial Cell Survival After Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK): Comparing the Pull-Through and Forceps Delivery Techniques. Invest. Ophthalmol. Vis. Sci. 2009;50(13):609.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the suture pull-through and forceps delivery techniques used in Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK).
A retrospective chart review of 56 eyes from 55 patients who underwent DSAEK between December of 2005 and September of 2007 at the University of Iowa was performed. All eyes included in the study had at least 12 months of post-operative followup. Outcome measures included best spectacle-corrected visual acuity (BSCVA), central corneal thickness, and endothelial cell density (ECD). These were compared at 12 months post-operatively. Because not all patients had all outcome measures recorded at their 12 month post-operative visit, most recent outcome measures, which could range from 6 months to 24 months post-operatively, were compared as well. Preoperative BSCVA, amount of followup, and donor characteristics were also compared between the two groups.
There was no significant difference between the groups in terms of preoperative BSCVA or length of follow-up. Differences in all donor characteristics, including age, death-to-preservation time, preservation-to surgery time, ECD, lenticule thickness, and lenticule diameter, failed to reach statistical significance. At 12 months from surgery, mean BSCVA in the forceps delivered group was 0.27 logMAR (range 0.0-1.0 logMAR) and 0.31 logMAR (range 0.0-1.1 logMAR) in the suture pull-through group. Mean central corneal thickness was 627 + 53 µm in the forceps delivered group and 628 + 47 µm in the suture pull-through group. Percentage ECD loss was 52 + 22% in the forceps delivered group and 54 + 29% in the suture pull-through group. None of these outcomes showed a statistically significant difference. Most recent BSCVA was 0.26 logMAR (range 0.0-0.7 logMAR) in the forceps delivered group and 0.32 logMAR (0.0-1.1 logMAR) for the suture-pull through group. Mean central corneal thickness at last follow-up visit was 634 + 47 µm and 641 + 67 µm in the forceps delivered and suture pull-through groups, respectively. Percentage ECD loss was 51 + 21% in the forceps delivered group and 44 + 22% in the suture pull-through group. None of these outcomes showed a statistically significant difference.
The suture pull-through and forceps delivery method of performing DSAEK offer comparable outcomes in regards to best-corrected visual acuity, pachymetry, and endothelial cell loss after 12 months of follow-up.
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