Effect of Donor Graft Thickness on Clinical Outcomes after Descemet Stripping Automated Endothelial Keratoplasty.

Sepehr Feizi,Mohammadali Javadi

doi:10.4103/jovr.jovr_55_17

Abstract

Purpose:To evaluate the effects of donor graft thickness on postoperative best spectacle-corrected visual acuity (BSCVA), refractive outcomes, endothelial cell density (ECD) and function, intraocular pressure (IOP), and postoperative complications after Descemet stripping automated endothelial keratoplasty (DSAEK).Methods:This retrospective, interventional case series enrolled 77 eyes of 64 patients who underwent DSAEK with or without simultaneous cataract surgery. Clinical outcomes, including BSCVA, refraction, keratometric astigmatism, IOP, and ECD were assessed at the final follow-up examination. Univariate analyses were used to investigate the effects of postoperative donor graft thickness on clinical outcomes and complications.Results:The mean patient age was 62.3 ± 15.6 years, and the patients were followed for 26.2 ± 20.9 months postoperatively. The mean postoperative central graft thickness was 102.4 ± 31.6 μm. In the univariate analysis, postoperative central graft thickness was significantly associated with postoperative IOP (P = 0.005), central recipient thickness (P = 0.002), and ECD (P = 0.016). No significant association was found for central graft thickness with postoperative BSCVA (P = 0.70), spherical equivalent refraction (P = 0.33), keratometric astigmatism (P = 0.27), graft detachment (P = 0.16), graft decentration (P = 0.17), high IOP (P = 0.53), or endothelial rejection (P = 0.88).Conclusion:This study failed to demonstrate any significant correlation between graft thickness and BSCVA. Attempting to minimize graft thickness might not have the desired outcome regarding endothelial cell density and function. Increased graft thickness could negatively impact the accuracy of IOP measurements after DSAEK.

Highlights

The present study investigated the effects of donor graft thickness on clinical outcomes and complications after Descemet stripping automated endothelial keratoplasty (DSAEK)
Our results showed that visual acuity following ultrathin DSAEK does not differ substantially from that after conventional DSAEK
We evaluated the influence of lamellar thickness on visual recovery, and we failed to show that the time to achieve best spectacle‐corrected visual acuity (BSCVA) varied between the two groups, indicating that graft thickness had no relationship with the rapidity of visual recovery

Summary

Introduction

Descemet stripping automated endothelial keratoplasty (DSAEK) is preferred over full‐thickness penetrating keratoplasty (PK) for corneal decompensation. Effect of donor graft thickness on clinical outcomes after descemet stripping automated endothelial keratoplasty. Effect of Donor Graft Thickness on DSAEK Outcomes; Feizi et al secondary to endothelial dysfunction. Visual performance is often sub‐optimal following DSAEK, and fewer patients than expected achieve best‐corrected visual acuity (BCVA) of 20/20 despite healthy grafts and no ocular comorbidities.[3,4,5,6] The reasons for these visual outcomes remain unclear, with theories including sub‐epithelial and anterior stromal changes, differences in graft thickness and regularity, the nature of the donor‐recipient interface, and induced high order aberrations.[5,6,7]

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