Purchase this article with an account.
T. Inatomi, H. Adachi, H. Tanioka, O. Hieda, S. Kinoshita; Corneal Endothelial Cell Loss and Graft Thickness Following Descemet-Stripping Automated Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2010;51(13):743.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To report the clinical outcomes of Descemet-Stripping Automated Endothelial Keratoplasty (DSAEK) focusing on the alteration of corneal endothelial cell density (ECD) and graft thickness.
Clinical outcomes of DSAEK were evaluated retrospectively. Subjects involved 58 eyes in 56 cases including 11 eyes with pseudophakic bullous keratopathy (PBK), 18 eyes with laser iridotomy-induced bullous keratopathy, 11 eyes with Fuchs corneal dystrophy, 9 eyes with glaucoma-related disorders, and 9 other eyes. The minimum follow-up period in all cases was over 3 months. For the DSAEK, pre-cut donor corneas were inserted using a Busin glide. Specular microscopy was performed to monitor the ECD. VisanteTM OCT (Carl Zeiss) was used for corneal thickness measurement.
The average ECD of the donor corneas prior to pre-cut and post pre-cut was 2909±322 cells/mm2 and 2692±344 cells/mm2, respectively (Eye Bank records). The loss of ECD following the pre-cut procedure and the surgical DSAEK procedure was 7.5% and 20.4%, respectively. ECD gradually decreased to 2143±424 cells/mm2, 1928±525 cells/mm2, 1776±591 cells/mm2, and 1644±599 cells/mm2, at 1-, 6-, 12-, and 18 months post surgery, respectively. The loss of CED following the pre-cut procedure and the surgical DSAEK procedure was 9.1% and 20.6%, respectively. Postoperative follow-up showed that in 36 cases at more than 6 months after DSAEK, 19 cases showed reduction rates of CED between 1 month and the latest follow-up to be less than 10%, yet 17 cases showed a reduction rate of over 10% (average: 35.5%). The average of host corneal thickness altered from 767µm to 483µm at 1 month after the DSAEK procedure. The whole thickness of the central cornea after 12 months was 666µm, with no significant difference to that of at 1 month. However, the average of peripheral corneal thickness gradually reduced from 887µm (at 1 month) to 786µm (at 12 months).
The results of this study show that DSAEK is an effective procedure for the recovery of corneal endothelial function and visual function. Graft wound-healing and corneal endothelial remodeling was shown to be influenced by multiple factors and continued for over 6 months after surgery.
This PDF is available to Subscribers Only