Author reply

Abstract

We thank Drs. Terry and Shamie for their instructive comments regarding our manuscript, “A clinicopathologic series of primary graft failure after Descemet's stripping and automated endothelial keratoplasty (DSAEK).”1Oster S.F. Ebrahimi K.B. Eberhart C.G. et al.A clinicopathologic series of primary graft failure after Descemet's stripping and automated endothelial keratoplasty.Ophthalmology. 2009; 116: 609-614Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar The single case of eccentric trephination noted in our series occurred early in the DSAEK experience at our institution; however, this occurrence, as well as the published work of DSAEK pioneers such as Drs. Terry and Shamie, underscores the importance of proper tissue preparation.We wholeheartedly agree that with meticulous surgical technique, eccentric trephination is a “preventable” DSAEK complication. Currently at our institution, all surgeons incorporate aspects of the guidelines delineated by Drs. Terry and Shamie to prevent eccentric trephination. In addition, Tissue Banks International now provides microkeratome prepared DSAEK tissue in which a crescent blade has been used to extend the lamellar dissection beyond the cut edge of the stromal bed. This additional dissection is performed after the microkeratome pass, while the donor corneoscleral tissue is still mounted on an artificial anterior chamber, and provides additional insurance against full-thickness donor edges resulting from trephination outside the border of the microkeratome section. Our experience suggests that outcomes with donor tissue prepared in this manner are similar to results using the standard method of donor tissue preparation without lamellar dissection of the peripheral donor cornea. We thank Drs. Terry and Shamie for their instructive comments regarding our manuscript, “A clinicopathologic series of primary graft failure after Descemet's stripping and automated endothelial keratoplasty (DSAEK).”1Oster S.F. Ebrahimi K.B. Eberhart C.G. et al.A clinicopathologic series of primary graft failure after Descemet's stripping and automated endothelial keratoplasty.Ophthalmology. 2009; 116: 609-614Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar The single case of eccentric trephination noted in our series occurred early in the DSAEK experience at our institution; however, this occurrence, as well as the published work of DSAEK pioneers such as Drs. Terry and Shamie, underscores the importance of proper tissue preparation. We wholeheartedly agree that with meticulous surgical technique, eccentric trephination is a “preventable” DSAEK complication. Currently at our institution, all surgeons incorporate aspects of the guidelines delineated by Drs. Terry and Shamie to prevent eccentric trephination. In addition, Tissue Banks International now provides microkeratome prepared DSAEK tissue in which a crescent blade has been used to extend the lamellar dissection beyond the cut edge of the stromal bed. This additional dissection is performed after the microkeratome pass, while the donor corneoscleral tissue is still mounted on an artificial anterior chamber, and provides additional insurance against full-thickness donor edges resulting from trephination outside the border of the microkeratome section. Our experience suggests that outcomes with donor tissue prepared in this manner are similar to results using the standard method of donor tissue preparation without lamellar dissection of the peripheral donor cornea. Avoiding Eccentric TrephinationOphthalmologyVol. 116Issue 12PreviewWe read with interest the 2 articles on the histopathology of failed grafts following Descemet's stripping automated endothelial keratoplasty (DSAEK) surgery which were written by Suh et al from Bascolm Palmer1 and by Oster et al from Wilmer Eye Institute.2 The authors are to be congratulated on their beautiful figures which clearly and concisely demonstrated the histopathology of failed DSAEK grafts from endothelial devastation and interface problems, calling attention to the paramount importance of protecting the donor endothelium at every stage of the DSAEK procedure. Full-Text PDF