Visual Outcomes and Graft Thickness in Microthin DSAEK—One-Year Results. Issue 11 (November 2015)

• Record Type: Journal Article
• Authors: Roberts, Harry W.; Mukherjee, Achyut; Aichner, Heidi; Rajan, Madhavan S.
• Is Part Of: Cornea. Volume 34:Issue 11(2015)
• Publication Date: 2015-11
• Subjects: endothelial keratoplasty -- DSAEK -- microthin DSAEK -- graft thickness; Cornea -- Periodicals; Cornea -- Periodicals; Cornée -- Périodiques; 617.719
• DOI: 10.1097/ICO.0000000000000596
• Languages: English
• ISSNs: 0277-3740

Abstract

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.