Graft Preparation Delays And Impact On Graft Detachment Rates In Descemet Stripping Automated Endothelial Keratoplasty

To study whether graft preparation delays and methods have an impact on rate of graft detachment rates in Descemet stripping automated endothelial keratoplasty (DSAEK).

Single academic tertiary care center and eye bank.

This is a retrospective cohort study using the prospectively-collected Eye Bank registry of the CHU de Québec – Université Laval, which include patients starting in October 2020. All patients with a minimum of 6 months postoperative follow-up after DSAEK were included in the study. All grafts were pre-cut at the Eye Bank by trained technicians. Patients were classified based on delay between graft preparation and surgery <3 days and ≥3 days groups. Graft detachment was identified by the treating surgeon and includes partial detachments not requiring rebubbling. Demographics, intraoperative characteristics, and postoperative outcomes were compared by groups.

There were 81 patients included with 40 (49%) in the ≥3 days group. Median [Q1, Q3] delay between graft preparation and surgery was 3.0 [1.9, 4.0] days. Mean±SD age was 74±10 years, 46 (57%) were female, 23 (28%) were phakic, 30 (37%) had previous grafts, and 61 (75%) underwent combined procedures. These characteristics and other graft preparation factors including cellular density, pachymetry, delay between death and conservation, donor age, graft size mismatch, conservation solution, and microbiology cultures did not differ by groups. There were 13 graft detachments (<3 days: 5 (12%) vs. ≥3 days: 8 (20%); RR = 0.61, 95% CI: 0.22-1.71; p=0.34) which required no rebubbling in 2, one rebubbling in 7, and two in 4 (p=0.47 by groups).

In this registry-based study, delay of graft preparation to surgery did not significantly alter risk of graft detachment. This insight may offer greater flexibility to eye banks in preparing DSAEK grafts.