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Outcomes of ultra-thin Descemet's stripping automated endothelial keratoplasty (DSAEK) using preloaded, pre-cut donor tissue

Poster Details

First Author: C.Bovone ITALY

Co Author(s):    A. Ruzza   D. Ponzin   Y. Nahum   M. Busin     

Abstract Details



Purpose:

To report the clinical outcomes of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) using pre-cut donor tissue preloaded in a modified Busin glide.

Setting:

Prospective, interventional case series of eyes operated at a private hospital by a single surgeon (MB).

Methods:

All consecutive patients undergoing DSAEK at our Institution since May 2013 were enrolled into a prospective study aimed at evaluating the use of pre-cut donor tissue for ultrathin DSAEK, preloaded into e modified Busin glide at the Fondazione Banca degli Occhi del Veneto (Venice, Italy). Before shipment, the eye bank measured thickness and contour of donor tissue by means of a modified anterior segment OCT (Tomey, Nagoya, Japan), as well as endothelial cell density (ECD) by inverted light microscopy after trypan blue staining. Standard DSAEK included descemetorhexis under air and bimanual delivery of the pre-cut, preloaded tissue under infusion of balanced salt solution through an anterior chamber maintainer placed at the 12 o'clock position. Main outcome measures were surgical time, postoperative best spectacle-corrected visual acuity (BSCVA), speed of visual recovery, and ECD.

Results:

Fourteen eyes of 14 patients undergoing DSAEK using pre-cut, preloaded ultrathin DSAEK grafts were included in the study. Indications for surgery were Fuchs' dystrophy (n=8), pseudophakic bullous keratopathy (n=3), posterior polymorphous dystrophy (n=2), and previous DSAEK failure (n=1). The mean surgical time was 21 minutes. The average follow-up time ranged from 3 to 18 months (average 8.2 months). In all patients without co-morbidities (n=9), BSCVA improved from 20/400 or worse preoperatively to 20/25 or better as early as 3 months after surgery. ECD of donor tissue measured at the eye bank was 2740±91cells/mm2, and mean graft thickness was 102±38μm. Six months after DSAEK, mean ECD was 2040±297cells/mm2, with a 25%. cell loss from eye bank values. No complications were recorded during preparation at the eye bank, intraoperatively or postoperatively.

Conclusions:

Pre-cut, preloaded donor tissue minimizes the surgical time required for DSAEK. Visual outcomes, postoperative endothelial cell loss, and complication rates do not differ from those recorded after conventional DSAEK. Possible complications related to the preparation and loading of the donor tissue onto delivery tools are eliminated. Especially for low-volume surgeons, increased costs related to pre-cutting and preloading the tissue are easily balanced by the reduction in surgical time and surgical tools required. FINANCIAL INTEREST: One of more of the authors... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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