Harry W Roberts1, Achyut Mukherjee, Heidi Aichner, Madhavan S Rajan. 1. *Cataract and Cornea Service, Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge, United Kingdom; and †Vision and Eye Research Unit (VERU), Postgraduate Medical Institute, Anglia Ruskin University, Cambridge, United Kingdom.
Abstract
PURPOSE: To evaluate visual outcomes, endothelial graft thickness, and complications in microthin Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: A prospective interventional cohort of 130 eyes of 114 consecutive patients underwent microthin DSAEK. Endothelial graft preparation included pachymetry-controlled stromal dehydration to reduce donor thickness between 550 and 530 μm by a custom airflow device, before a single-pass microkeratome dissection with a uniform cutting head of 350 μm to achieve microthin endothelial grafts (<130 μm). Data on visual acuity, graft thickness, endothelial cell loss, and complication rates were analyzed. RESULTS: Pachymetry-controlled donor preconditioning reduced donor thickness on average by 67 μm (range 0-186, SD 44.7) from 590 μm (range 485-806, SD 53) to 528 μm (range 480-620, SD 23), P < 0.01, and allowed graft preparation without any case of intraoperative graft loss or perforation. The resultant mean graft thickness was 94 μm (SD 25) intraoperatively, 94 μm (SD 26) at 1 month, and 90 μm (SD 19) at 12 months. Of note, 98.2% of eyes without significant visual comorbidity achieved best-corrected Snellen acuity of 6/9 or more at 12 months. There was a 35.8% and 41% reduction in endothelial cell density at 3 and 12 months, respectively. Postoperative graft detachment occurred in 5% of cases (1.7% in uncomplicated eyes). There was no graft loss during preparation, and none developed immune rejection during the study period. CONCLUSIONS: The microthin DSAEK procedure offers a simple and safe technique to prepare thin endothelial grafts with a low risk of graft wastage, low risk of postoperative detachment, and visual results that are comparable to those of other thin endothelial keratoplasty procedures.
PURPOSE: To evaluate visual outcomes, endothelial graft thickness, and complications in microthin Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: A prospective interventional cohort of 130 eyes of 114 consecutive patients underwent microthin DSAEK. Endothelial graft preparation included pachymetry-controlled stromal dehydration to reduce donor thickness between 550 and 530 μm by a custom airflow device, before a single-pass microkeratome dissection with a uniform cutting head of 350 μm to achieve microthin endothelial grafts (<130 μm). Data on visual acuity, graft thickness, endothelial cell loss, and complication rates were analyzed. RESULTS: Pachymetry-controlled donor preconditioning reduced donor thickness on average by 67 μm (range 0-186, SD 44.7) from 590 μm (range 485-806, SD 53) to 528 μm (range 480-620, SD 23), P < 0.01, and allowed graft preparation without any case of intraoperative graft loss or perforation. The resultant mean graft thickness was 94 μm (SD 25) intraoperatively, 94 μm (SD 26) at 1 month, and 90 μm (SD 19) at 12 months. Of note, 98.2% of eyes without significant visual comorbidity achieved best-corrected Snellen acuity of 6/9 or more at 12 months. There was a 35.8% and 41% reduction in endothelial cell density at 3 and 12 months, respectively. Postoperative graft detachment occurred in 5% of cases (1.7% in uncomplicated eyes). There was no graft loss during preparation, and none developed immune rejection during the study period. CONCLUSIONS: The microthin DSAEK procedure offers a simple and safe technique to prepare thin endothelial grafts with a low risk of graft wastage, low risk of postoperative detachment, and visual results that are comparable to those of other thin endothelial keratoplasty procedures.
Authors: Kevin W Ross; Christopher G Stoeger; George O D Rosenwasser; Robert C OʼBrien; Loretta B Szczotka-Flynn; Allison R Ayala; Maureen G Maguire; Beth Ann Benetz; Patricia Dahl; Donna C Drury; Steven P Dunn; Sameera M Farazdaghi; Caroline K Hoover; Marian S Macsai; Shahzad I Mian; Michael L Nordlund; Jeffrey G Penta; Mark C Soper; Mark A Terry; David D Verdier; Doyce V Williams; Jonathan H Lass Journal: Cornea Date: 2019-09 Impact factor: 3.152