Endothelial keratoplasty: a comparison of complication rates and endothelial survival between precut tissue and surgeon-cut tissue by a single DSAEK surgeon.

Purpose: Descemet stripping automated endothelial keratoplasty (DSAEK) can be performed with donor tissue prepared with a microkeratome either by the surgeon at the time of surgery or by a technician in the eye bank days before surgery. Are the complications and endothelial survival affected by donor preparation by a surgeon vs a technician?

Methods: A single surgeon at a referral practice performed 225 DSAEK procedures for Fuchs endothelial dystrophy using a similar surgical technique for all cases. Surgeon-cut tissue was used in 49 cases (group 1), and precut tissue was used in 176 cases (group 2). Retrospective analysis was done from a prospectively collected database for donor dislocations, iatrogenic primary graft failure (IPGF), and 6- and 12-month postoperative central endothelial cell density (ECD).

Results: There were no dislocations in group 1 and 3 dislocations in group 2 (P = .224). There were no IPGFs in group 1 and one IPGF in group 2. The preoperative donor ECD was 2948 +/- 382 for group 1 and 2728 +/- 269 for group 2. (P < .001). The cell loss at 6 months was 33% +/- 14% for group 1 and 27% +/- 13% for group 2 (P = .01), and cell loss at 12 months was 34% +/- 13% for group 1 and 27% +/- 14% for group 2 (P = .01). Six-month cell loss for 8.0-mm grafts (n=127) was 30% +/- 16% and for larger grafts (n=98) was 27% +/- 12% % (P = .296).

Conclusions: Precut tissue for DSAEK does not increase the risk of the acute complications of graft dislocation or IPGF. Early endothelial cell loss may be less with precut tissue. Larger graft sizes did not result in significantly higher cell counts at 6 months.