alexa Effect of incision width on graft survival and endothelial cell loss after Descemet stripping automated endothelial keratoplasty.
Surgery

Surgery

Journal of Transplantation Technologies & Research

Author(s): Price MO, Bidros M, Gorovoy M, Price FW Jr, Benetz BA,

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Abstract PURPOSE: To assess the effect of incision width (5.0 and 3.2 mm) on graft survival and endothelial cell loss 6 months and 1 year after Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: One hundred sixty-seven subjects with endothelial decompensation from a moderate-risk condition (principally Fuchs dystrophy or pseudophakic corneal edema) underwent DSAEK by 2 experienced surgeons. The donor was folded over and inserted with single-point fixation forceps. This retrospective analysis assessed graft survival, complications, and endothelial cell loss, which was calculated from baseline donor and 6-month and 1-year postoperative central endothelial images evaluated by an independent specular microscopy reading center. RESULTS: No primary graft failures occurred in either group. One-year graft survival rates were comparable (98\% vs 97\%) in the 5.0- and 3.2-mm groups, respectively (P = 1.0). Complications included graft dislocation, graft rejection episodes, and elevated intraocular pressure and occurred at similar rates in both groups (P > or = 0.28). Pupillary block glaucoma did not occur in either group. Mean baseline donor endothelial cell density did not differ: 2782 cells per square millimeter in the 5.0-mm (n = 64) and 2784 cells per square millimeter in the 3.2-mm (n = 103) groups. Percent endothelial cell loss was 27\% +/- 20\% (n = 55) versus 40\% +/- 22\% (n = 71; 6 months) and 31\% +/- 19\% (n = 45) versus 44\% +/- 22\% (n = 62; 12 months) in the 5.0- and 3.2-mm incision groups, respectively (both P < 0.001). CONCLUSIONS: One year after DSAEK, overall graft success was comparable for the 2 groups; however, the 5.0-mm incision width resulted in substantially lower endothelial cell loss at 6 and 12 months.
This article was published in Cornea and referenced in Journal of Transplantation Technologies & Research

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