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D. M. Spokes, A. Rice, A. Khan, J. L. Ball; Endothelial Cell Survival and OCT Graft Profile Analysis Following Descemet Stripping Endothelial Keratoplasty with Manual Graft Dissection. Invest. Ophthalmol. Vis. Sci. 2009;50(13):629.
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Descemet stripping endothelial keratoplasty (DSEK) offers improved vision and comfort for individuals with corneal endothelial dysfunction. The outcome depends on a graft morphology which optimises visual potential and survival of an adequate endothelial cell population to maintain corneal clarity. The purpose of this study is to evaluate the outcomes of DSEK in terms of endothelial cell counts, graft survival and graft profiles from a single-institution, single-surgeon series with at least 12 month follow-up. This study had Ethics Committee approval.
All patients who had undergone DSEK during 2006-7 were evaluated. Endothelial grafts were obtained by manual dissection using the Barron anterior chamber maintainer and the Morlet lamellar dissector. Anterior segment OCT (AS-OCT) images were used to measure graft thickness and uniformity. The ratio between central graft thickness and mean graft thickness at points 1.5mm away from the centre was used to assess uniformity of profile (C:P ratio). Endothelial cell counts were measured by specular microscopy.
23 eyes of 22 patients were assessed. Mean age at surgery was 69years. Mean endothelial cell loss at 12 months was 33% (range 19.5-41.5%). There was one primary graft failure (4%). 3 patients (12.5%) experienced graft rejection which was reversed with intensive topical steroids. The single instance of graft dislocation (4%) was successfully managed by re-bubbling. AS-OCT images were obtained for all patients. Overall mean graft thickness was 162µm. Mean central graft thickness was 157µm. Mean graft thickness 1.5mm from centre was 164µm. The mean C:P ratio was 0.97. 3 grafts had a meniscus profile, the remainder were planar in profile (C:P ratio between 0.9 and 1.1).
A viable graft of suitable thickness and profile can be obtained by manual dissection. AS-OCT is a useful tool in obtaining high-resolution imaging and measurements in analysis of graft profiles. DSEK enables replacement of endothelial tissue with low complication rate and good preservation of endothelial cells. Close surveillance and prompt treatment of rejection are needed.
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