Effect of Incision Size on Endothelial Cell Loss 1-Year Following DSAEK

Abstract

Purpose: : Assess primary donor failure and dislocation rates, graft success, and endothelial cell loss at six months and one year after Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) with differing incision widths used at two clinical sites by two experienced surgeons.

Methods: : A prospective series of 172 DSAEK cases[n=102 (MG) and =70 (FP)] were performed at two sites with differing incision widths [3.2-mm clear cornea (MG) and 5.0 mm scleral or clear cornea (FP)] and were analyzed for primary donor failure rate, dislocations, complications, and graft success and endothelial cell loss after 1 year. Results compared to the Cornea Donor Study have been previously reported (ARVO 2008 abstract 1936). Specular endothelial images of the donors along with images taken at 6 and 12 months postoperatively were analyzed by the Specular Microscopy Reading Center (CWRU) to determine endothelial cell density. This report compares the results for the two sites with differing incision widths for same parameters.

Results: : No primary donor failures occurred at either site. 5 and 0 patients experienced dislocations (MG and FP, respectively); all grafts were successfully repositioned with air rebubbling. Graft success was 99% at both sites at one year with one late graft failure at each site. Complications after one month were similar between the two sites. Six-month and one year % endothelial cell loss were 40% ± 23 (± SD) and 43 ± 25 for the 3.2-mm incision group, and 25% ± 21 and 25% ± 22 for the 5-mm incision group, respectively (p=0.001 at 6 months and p=0.002 at one year).

Conclusions: : Six-month endothelial cell loss was significantly greater for 3.2-mm incision compared to 5.0-mm incision DSAEK, with no statistically significant increase in cell loss between 6 months and 1 year in either group. Graft success was 99% in both groups at 1 year.

Keywords: cornea: endothelium • cornea: clinical science • transplantation