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A. Anshu, J. S. Mehta, H. Cajucom-Uy, D. T. H. Tan; Donor Risk Factor Analysis for Primary Graft Failure Following Descemets Stripping Automated Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1938.
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Descemet's stripping automated endothelial keratoplasty (DSAEK) has been shown to have superior refractive and visual results compared to conventional penetrating keratoplasty but higher rates of primary graft failure (PGF) have been reported. We report results of a donor risk factor analysis as to the cause of PGF in our series of DSAEK cases in Chinese eyes.
PGF was diagnosed based on previously published criteria. Donor details examined were; age of donor, cause of donor death, death to harvesting time, donor storage time, distribution distance of tissue, preoperative endothelial cell count and method of donor insertion. Cases of PGF were compared with control cases (those that had undergone a successful procedure), significance value p< 0.05.
Five patients had PGF following DSAEK. One patient had 2 failures, hence six (12%) out of 50 DSAEK procedures. There was no statistical difference in the demographic information between the PGF and control cases. Four of the PGF cases were donor mates. All corneas were preserved in Optisol GS. There was no significant difference between the two groups (PGF v control) for; cadaver time, storage time, source of tissue, preoperative endothelial cell count, donor age and cause of death. There was a significantly less PGF following glide insertion than 'taco' (p= 0.0029, OR 10).
Surgical trauma is a factor for PGF following DSAEK in our series, and not donor retrieval, transportation or eye banking procedures. Efforts must be made to reduce endothelial cell loss during donor insertion.
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