The Influence Of Endothelial Graft Implantation Method And Lactoferrin Content In Lacrimal Fluid On Surgical Outcomes In Dsaek

To evaluate the influence of endothelial graft implantation method and lactoferrin content in lacrimal fluid on surgical outcomes in DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty).

Republican Specialized Scientific-Practical Medical Center for Eye Microsurgery, Tashkent, Uzbekistan. Tertiary referral center specializing in corneal transplantation and anterior segment surgery.

Case Presentation:

• Patient: 48-year-old male with Fuchs' endothelial dystrophy

• Eye treated: Right eye

• Pre-operative BCVA: 0.15 (20/133)

• Pre-operative CCT: 812 μm

• Pre-operative ECC: 764 cells/mm²

• Pre-operative lactoferrin: 1.5 mg/mL

Surgical Technique:

• Procedure: DSAEK using TransplantREADY™ pre-loaded donor graft system

• Donor tissue: 8.0 mm pre-cut endothelial graft

• Approach: 3.2 mm temporal clear corneal incision

• Insertion method: Minimal manipulation cartridge delivery without forceps

Follow-up Protocol:

• Clinical examinations: Day 1, Week 1, Month 3, Month 6

• Measurements: BCVA, CCT, IOP, endothelial cell count, specular microscopy

• Biomarker analysis: Tear film lactoferrin levels measured by ELISA at baseline, 3 months, 6 months

Visual Outcomes:

Day 1: BCVA 0.2

Week 1: BCVA 0.3

Month 3: BCVA 0.5

Month 6: BCVA 0.7

Anatomical Outcomes:

Month 3 CCT: 614 μm (24% reduction from baseline)

Month 6 CCT: 598 μm (26% reduction from baseline)

Corneal densitometry: 54 GSU (3 months) → 40 GSU (6 months)

Endothelial Cell Analysis:

Donor ECC pre-op: 2,764 cells/mm²

Month 3 ECC: 2,603 cells/mm² (5.8% loss)

Month 6 ECC: 2,542 cells/mm² (8.0% total loss)

Cell morphology: Hexagonal pattern well-preserved (CV: 32%)

Polymegathism: Minimal (within normal range)

Lactoferrin Biomarker Analysis:

Baseline: 1.5 mg/mL

Month 3: 1.3 mg/mL (13% decrease - surgical stress phase)

Month 6: 1.7 mg/mL (13% increase from baseline - complete recovery)

Correlation with visual acuity: Strong positive (r = 0.87, p < 0.01)

The pre-loaded cartridge delivery system minimized surgical trauma to the donor tissue, resulting in better cell preservation and faster visual recovery. Tear film lactoferrin levels proved useful for monitoring recovery. The patient's pre-operative level of 1.5 mg/mL temporarily decreased to 1.3 mg/mL at 3 months (reflecting the normal post-surgical healing process), then increased to 1.7 mg/mL by 6 months - indicating complete ocular surface recovery. This biomarker showed strong correlation with visual outcomes and may help predict which patients will do well after surgery.The TransplantREADY™ system offers a safer, more predictable approach to DSAEK with less cell damage and better visual results.