SURGEON-CUT VERSUS PRE-CUT DONOR TISSUE IN

DESCEMET’S STRIPPING AND AUTOMATED

ENDOTHELIAL KERATOPLASTY (DSAEK)

Lori Lombardi MD, Mark A. Terry MD,Neda Shamie MD, Anand K. Shah MD, Daniel J. Friend

MS*Dr. Terry has a financial interest in Bausch & Lomb instruments he

developed for DSAEKOther authors have no financial interest

DD

Introduction DSAEK surgery has revolutionized treatment for

various forms of corneal endothelial dysfunction Successful replacement of damaged

endothelium with graft tissue relies on surgical technique as well as favorable tissue characteristics

Previously, surgeons prepared the donor posterior lenticule at the time of surgery

Now, “precut” donor tissue may be prepared by the tissue bank using a Moria microkeratome and artificial anterior chamber system

Purpose

This large scale, prospective study compares outcomes of DSAEK surgery using surgeon-cut versus pre-cut donor tissue

Methods

Patients were enrolled in an Institutional Review Board approved protocol for endothelial keratoplasty

Surgical data was gathered in a prospective fashion

Consecutive DSAEK surgeries were compared using Surgeon-cut tissue (n=114) versus Pre-cut tissue (n=207).

Outcome measures reviewed include: Best spectacle corrected visual acuity (BSCVA) Endothelial cell loss Rate of primary graft failure Graft dislocation rate

Results

Average BSCVA at 6 months: 20/37 for the Surgeon-cut group (n=114) 20/38 for the Pre-cut group (n=207) p = 0.745

Average BSCVA at 1 year: 20/33 for the Surgeon-cut (n=108) 20/42 for the Pre-cut (n=112) p = 0.044

With comorbidities removed, BSCVA at 1 year: 20/33 for the Surgeon-cut (n=106) 20/41 for Pre-cut (n=108) p = 0.72

Best Spectacle-Corrected Visual Acuity

Six Months One Year0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

BSCVA (Co-morbidities removed)

PrecutSurgeon cut

Time

LogM

AR

VA

20/38

p = 0.745

20/41

20/33

p = 0.72

20/37

Endothelial Cell Loss

Endothelial cell loss at 6 months: Surgeon-cut = 35% Pre-cut = 29% p=0.002

Endothelial cell loss at 1 year: Surgeon-cut = 36% Pre-cut = 29% p = 0.009

Endothelial Cell Loss

Six Months One Year0%

5%

10%

15%

20%

25%

30%

35%

40%

Endothelial Cell Loss

Precut

Surgeon cut

Time

Perc

en

t C

ell L

oss

p = 0.009p = 0.002

29% 29%

35%36%

Complications

Primary graft failures: No primary graft failures occurred in either

group Dislocations:

Two dislocations occurred in the Surgeon-cut group

Ten dislocations in the Pre-cut group p=0.421

Conclusion

In this large-scale, prospective study, DSAEK using either Surgeon-cut or Pre-cut tissue resulted in comparable patient outcomes and surgical results

BSCVA was not statistically different between groups

Endothelial loss was higher in Surgeon-cut tissue Dislocations occurred more often in the Pre-cut

group Study includes graft preparation and surgery

performed by less experienced surgeons, which may factor into the overall outcomes