Risk Factors For Donor Graft Detachment In Descemet Stripping Endothelial Keratoplasty

Published 2023 - 41st Congress of the ESCRS

Reference: PO0665 | Type: Free paper | DOI: 10.82333/xjks-aq66

Authors: Luis Alberto Rodriguez* ¹ , Guillermo De Wit ¹ , Pedro Ivan Navarro Naranjo ¹ , Emmanuel Cabrera ¹ , Emmanuel Romero ¹ , Itzel Martínez ¹

¹Cornea,APEC,CDMX,Mexico

Purpose

1.- To describe the risk factors associated with donor graft detachment in eyes in which Descemet stripping endothelial keratoplasty was performed

2.- To report the association between previous ocular surgeries and donor graft detachment in eyes in which Descemet stripping endothelial keratoplasty was performed

3. To report the association between endothelial donor graft thickness prior to surgery and donor graft detachment in eyes in which Descemet stripping endothelial keratoplasty was performed

4.- To report the association between tissue preservation time prior to surgery and donor graft detachment in eyes in which Descemet stripping endothelial keratoplasty was performed

Setting

Recent reports from international eye banks have shown an increase in the request for tissues for endothelial keratoplasties (DSAEK and DMEK).
These techniques are being performed more commonly than penetrating keratoplasties in different countries.
However DSAEK surgery has different complications than a PKP, such as graft detachment.
The main objective of this study is to evaluate the association between risk factors for donor graft detachment in patients in wich a DSAEK surgery was performed.

Methods

Cross-sectional, analytical, retrospective cohort study Study carried out in the Cornea Service of Asociación Para Evitar la Ceguera en Mexico. 
All patients undergoing DSAEK endothelial keratoplasty from 2015 to 2022 at the APEC Department of Cornea and Refractive Surgery were analyzed.
An anterior segment OCT was performed to allow non-invasive acquisition of high-resolution optical images of the cornea, in order to follow-up patients after the surgery. 
The sample was calculated using the expected proportion of patients with donor graft detachment in DSAEK surgery (Bhalerao et al. of 14.5%) with a confidence level of 95%, for an initial sample of 56 patients, and as expecting possible losses (20%) for a final sample of 68 patients.

Results

181 DSAEK surgeries were analyzed, 53% were women and 47% men with a mean age of 66.2 years.
The most frequent cause for endothelial keratoplasty was pseudophakic bullous keratopathy in 56% of eyes. 
The mean pre-opertative corneal thickness was 774 microns, at 3 months the corneal thickness was 592 microns. 
Patients had a visual acuity of 20/500 preoperatively which improved to 20/100 at 3 months, however vision declined to 20/200 at one year. 
A statistically significant relationship was found between donor graft thickness and the risk of detachment of the donor tissue, if donor graft thickness at 24 hours was greater than 280 microns or a donor graft thickness greater than 215 microns at 1 week after surgery

Conclusions

Patients were almost equally distributed between men and women
Most of the patients were older than 50 years with a mean age of 66.2 years
Corneal thickness and the donor graft continued to decrease during the first 3 months, which translated into an improvement in vision; however after 1 year vision decreased, but corneal thickness remained stable. 
An association was found between donor graft detachment and a donor graft thickness >280 microns one day after surgery  and a donor graft thickness >215 microns at the first week after surgery . 
With these findings we recommend to perform an anterior segment OCT in patients in which DSAEK surgery was performed at 24 hours and at the first week to analyze donor graft thickness.