Srheyans Jain1, Namrata Sharma, Prafulla K Maharana, Tushar Agarwal, Rajesh Sinha, Rasik B Vajpayee. 1. Dr. Rajendra Prasad Centre for Ophthalmic Sciences (S.J., N.S., T.A., R.S.), All India Institute of Medical Sciences, New Delhi, India; Department of Ophthalmology (P.K.M.), All India Institute of Medical Sciences, Bhopal, India; and Department of Ophthalmology (R.B.V.), Vision Eye Institute, Royal Victorian Eye and Ear Hospital, North West Academic Centre, University of Melbourne, Melbourne, Australia.
Abstract
PURPOSE: To compare the outcomes of 400-μm microkeratome head with 350-μm microkeratome head Descemet stripping automated endothelial keratoplasty (DSAEK) in a prospective comparative study. METHODS:Twenty cases of pseudophakic bullous keratopathy were randomly allocated into two groups. Group 1 underwent slow, single-pass 400-μm microkeratome head, whereas group 2 underwent the standard technique of DSAEK using a 350-μm microkeratome head. The primary outcome measures were best-corrected visual acuity (BCVA) at 6 months. RESULTS: Groups were comparable in baseline characteristics. The mean central graft thickness (GT) at 6 months in group 1 was significantly thinner than group 2 (90.44±28.67 vs. 165.60±62.74 μm; P=0.003). The BCVA and contrast sensitivity were significantly better in group 1 than in group 2 (BCVA: 0.34±0.15 vs. 0.53±0.19 logMAR units, P=0.02; contrast sensitivity: 1.48±0.13 vs. 1.06±0.22, P=0.001). A significant correlation was found between both postoperative BCVA and contrast sensitivity, with the postoperative GT using Spearman rho correlation analysis (R=0.534, P=0.01 for BCVA and R=-0.522, P=0.02 for contrast sensitivity). The percentage endothelial cell loss was comparable between the 2 groups at the last follow-up (P=0.3). No major complications were observed during the study period. CONCLUSIONS: The use of a 400-μm microkeratome head instead of 350-μm head can improve the visual outcomes in DSAEK without increasing the risk of complications. The thickness of the DSAEK graft can affect the visual acuity and contrast sensitivity.
RCT Entities:
PURPOSE: To compare the outcomes of 400-μm microkeratome head with 350-μm microkeratome head Descemet stripping automated endothelial keratoplasty (DSAEK) in a prospective comparative study. METHODS: Twenty cases of pseudophakic bullous keratopathy were randomly allocated into two groups. Group 1 underwent slow, single-pass 400-μm microkeratome head, whereas group 2 underwent the standard technique of DSAEK using a 350-μm microkeratome head. The primary outcome measures were best-corrected visual acuity (BCVA) at 6 months. RESULTS: Groups were comparable in baseline characteristics. The mean central graft thickness (GT) at 6 months in group 1 was significantly thinner than group 2 (90.44±28.67 vs. 165.60±62.74 μm; P=0.003). The BCVA and contrast sensitivity were significantly better in group 1 than in group 2 (BCVA: 0.34±0.15 vs. 0.53±0.19 logMAR units, P=0.02; contrast sensitivity: 1.48±0.13 vs. 1.06±0.22, P=0.001). A significant correlation was found between both postoperative BCVA and contrast sensitivity, with the postoperative GT using Spearman rho correlation analysis (R=0.534, P=0.01 for BCVA and R=-0.522, P=0.02 for contrast sensitivity). The percentage endothelial cell loss was comparable between the 2 groups at the last follow-up (P=0.3). No major complications were observed during the study period. CONCLUSIONS: The use of a 400-μm microkeratome head instead of 350-μm head can improve the visual outcomes in DSAEK without increasing the risk of complications. The thickness of the DSAEK graft can affect the visual acuity and contrast sensitivity.
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