Endothelial Keratoplasty: The Relationship between Donor Tissue Size and Donor Endothelial Survival

Abstract

To determine if donor graft diameter has a relationship with postoperative central endothelial cell density (ECD) and survival in Descemet's stripping automated endothelial keratoplasty (DSAEK). Retrospective, comparative analysis of an interventional case series. Three hundred thirty-one eyes of 243 patients undergoing DSAEK surgery for Fuchs' endothelial dystrophy without a history of rejection or graft dislocation. Descemet's stripping automated endothelial keratoplasty was performed in 331 eyes with Fuchs' dystrophy. After exclusion of confounding variables, postoperative ECD and percentage cell loss was compared for 8.0-mm grafts (n = 154) versus 8.5-mm grafts (n = 165) over a 2-year postoperative period. Total central ECD and percentage of donor endothelial cell loss as measured by specular microscopy of central ECD. Mean preoperative ECD was 2635 cells/mm(2) for 8.0-mm grafts and 2732 cells/mm(2) for 8.5-mm grafts (P = 0.003). Mean ECD (and percent cell loss from before surgery) was 2011 cells/mm(2) (22.9%) for 8.0-mm grafts and 2078 cells/mm(2) (23.5%) for 8.5-mm grafts at 6 months, 2009 cells/mm(2) (23.3%) and 2113 cells/mm(2) (23.1%) at 1 year, and 2060 cells/mm(2) (23.4%) and 2111 cells/mm(2) (24.3%) at 2 years (P>0.72 for percentage cell loss at all time points). Descemet's stripping automated endothelial keratoplasty grafts with a diameter of 8.5 mm do not offer a clinical advantage over smaller 8.0-mm grafts for postoperative endothelial cell counts in the first 2 years after surgery. Proprietary or commercial disclosure may be found after the references.