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First Author: M.Rajan UK
Co Author(s): A. Mukherjee H. Aichner
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To evaluate visual, refractive and surgical outcomes including endothelial graft thickness in Descemets stripping automated endothelial keratoplasty (DSAEK) with a novel surgical technique directed at obtaining thin donor grafts.
Vision and Eye Research Unit (VERU), Anglia Ruskin University and Cambridge University Hospitals, Cambridge, United kingdom.
In a prospective interventional cohort study 30 eyes of 29 consecutive patients undergoing micro-thin DSAEK were included. A novel technique involving pachymetry controlled stomal dehydration of donor corneas to reduce donor thickness to 530um was undertaken by a custom air flow device, prior to a single pass microkeratome dissection during graft preparation. Following DSAEK surgery, post operative assessment was performed at 1, 3 and 6 and 12 months and included ocular coherence tomography (OCT) corneal and graft thickness, endothelial specular microscopy and refraction. Main Outcome Measures: Visual acuity, endothelial graft thickness, endothelial cell loss and surgical complications.
Pachymetry controlled donor pre-conditioning reduced central corneal thickness to 537 um (SD 19) from 614 um (SD 44, p <0.0001) and allowed a single pass microkeratome dissection in all cases. The OCT mean endothelial graft thickness was 90.9um (SD 21) at 1 month, 86.1 um (SD 22) at 3 months, 82.6 um (SD 19) at 6 months and 82.2 um (SD 16) at 12 months with 100 % of eyes achieving best corrected Snellens acuity of 20/30 (logMar = 0.16) at 12 months. There was 35% reduction in endothelial cell density at 3 months post op compared to pre operative donor density and risk of graft detachment was 3 % in this study.
The micro-thin DSAEK protocol using the custom airflow device offers a reliable technique to yield sub 100 um thin endothelial grafts with a single microkeratome pass without risk of graft wastage and aids rapid postoperative visual recovery in patients with corneal endothelial decompensation.