Randomized, Prospective Comparison of Precut vs Surgeon-Dissected Grafts for Descemet Stripping Automated Endothelial Keratoplasty

• Published in: American journal of ophthalmology Vol. 146; no. 1; pp. 36 - 41.e2
• Main Authors: Price, Marianne O., Baig, Kashif M., Brubaker, Jacob W., Price, Francis W.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2008; Elsevier; Elsevier Limited
• Subjects: Aged; Automation; Biological and medical sciences; Cataracts; Cell Count; Corneal Transplantation - methods; Descemet Membrane - surgery; Dissection; Double-Blind Method; Endothelium; Endothelium, Corneal - pathology; Endothelium, Corneal - transplantation; Eye Banks - methods; Female; Fuchs' Endothelial Dystrophy - surgery; Health Insurance Portability & Accountability Act 1996-US; Histology; Humans; Hypertension; Hypotheses; Male; Medical sciences; Microscopy; Miscellaneous; Ophthalmology; Ophthalmology - methods; Patients; Prospective Studies; Refraction, Ocular; Shipments; Shipping industry; Specimen Handling - methods; Standard deviation; Surgery; Surgical outcomes; Treatment Outcome; Visual Acuity; California; Prospective; Stripping; Treatment; Keratoplasty; Surgery; Graft; Ophthalmology; Surgeon; Comparative study
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2008.02.024

To determine whether eye bank predissected corneal grafts provide outcomes comparable to surgeon-dissected grafts for Descemet stripping automated endothelial keratoplasty (DSAEK). Randomized, prospective, double-masked clinical trial. Twenty pairs of donor corneas were harvested. One cornea from each pair was randomized to be precut at an eye bank for next-day use. The surgeon dissected the fellow cornea intraoperatively using a comparable microkeratome and protocol. The corneas were randomly assigned to 40 subjects having DSAEK at a single center. Subjects and evaluators were masked and statistical significance was assessed using the paired t test. Mean subject age was 71 ± 12 years and 90% had Fuchs dystrophy. Mean endothelial cell loss was 32% at six months and 34% at one year; the two groups did not differ by a statistically significant amount at either time point ( P = .10 and P = .79, respectively). Each group experienced two early dislocations (10%), and grafts were repositioned successfully with a second air bubble. At six months, 28 of 35 patients (80%) had best-corrected vision of 20/40 or better, excluding five patients (12%) with preexisting retinal problems ( P = .48). Both groups experienced a mild hyperopic shift ( P = .82), and neither had a statistically significant increase in mean refractive cylinder ( P = .63). Histology from one subject's eye postmortem demonstrated that endothelial cells had migrated over the exposed edge of the donor stroma a year after surgery. Eye bank precut tissue provided similar endothelial cell loss, visual and refractive outcomes, and detachment rates compared with surgeon-dissected tissue.