Endothelial Keratoplasty: Does Donor Graft Size in Descemet’s Stripping Endothelial Keratoplasty (DSAEK) Affect Complication Rates or 6 Month Postoperative Outcomes?

Abstract

Purpose: : To compare the complication rates and 6 month best spectacle corrected visual acuity (BSCVA), percent endothelial cell loss and hyperopic shift in DSAEK eyes receiving a donor graft smaller than 8.5 mm to those with 8.5 mm or larger grafts.

Methods: : 356 eyes underwent DSAEK with 278 receiving donor grafts smaller than 8.5 mm and 78 receiving grafts of 8.5 mm or larger. Rate of graft dislocation and primary graft failure (PGF) was compared between the two groups as was 6 mo BSCVA and hyperopic shift. The percent endothelial cell loss as compared to donor endothelial cell density (ECD) was also compared between the two groups.

Results: : Of those with a graft smaller than 8.0 mm, 9 (3%) experienced graft dislocations; none developed primary graft failure (PGF). This was comparable (p=.107) to the group of eyes receiving grafts 8.5 mm or larger with only two dislocations (2.6%) and no PGF. At 6 mo, the mean BSCVA in the group with grafts smaller than 8.5 mm was 20/57 and in those with grafts 8.5 mm or larger was 20/49 (p=.313). All eyes with preoperative ocular comorbidities were excluded in assessing the postoperative VA. There was no significant difference (p=.714) in the hyperopic shift seen in the two groups; eyes with grafts smaller than 8.5 mm had a .87D hyperopic shift vs. a 1.08D shift for those with an 8.5 mm or larger graft. The only significant difference (p=.035) seen in the two groups at six months was in percent endothelial cell loss with the group receiving the smaller donor grafts (<8.5 mm) experiencing 34 % ECD loss versus 26 % ECD loss for those with the larger grafts (≥ 8.5 mm).

Conclusions: : Donor graft size does not appear to influence the rate of graft dislocation or primary graft failure in DSAEK surgery. 6 month visual acuity and percent endothelial cell loss is also equal in eyes receiving a donor graft smaller than 8.5 mm in diameter as compared to donor graft of 8.5 mm or larger. Percent loss of ECD at 6 months is lower in the eyes receiving the larger donor grafts; this may be indicative of the larger number of endothelial cells delivered and lessened peripheral migration of endothelial cells over time in these eyes receiving the larger donor grafts.

Keywords: cornea: endothelium • clinical (human) or epidemiologic studies: outcomes/complications