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Cornea and External Disease

For DSAEK, Does Technique Choice Matter?

Posted on December 4, 2018

When performing Descemet stripping automated endothelial keratoplasty (DSAEK), there is no evidence to suggest that one technique works better than another, said Mark A. Terry, a corneal specialist at Legacy Devers Eye Institute in Portland, OR, during the American Academy of Ophthalmology’s 2018 annual meeting in Chicago. “You can insert the tissue with an injector, pull-through, glide, or forceps.  None of that matters as long as you do it well.” 

Dr. Terry reported results of the Cornea Preservation Time Study, a multicenter, randomized, masked, noninferiority study involving 1,330 eyes. He found that success is more likely when the donor did not have diabetes and when there were no operative complications. Additionally, long-term success appears to be better in patients with Fuchs dystrophy vs those with pseudophakic or aphakic corneal edema (PACE).

Participants were a median 70 years of age and underwent DSAEK for either Fuchs endothelial corneal dystrophy (94%) or PACE (6%). They were randomized to receive donor cornea with preservation time of either 0 to 7 days (n=675) or 8 to 14 days (n=655). Investigators looked at graft success at 3 years. Among the results: 

⦁    Overall, 94% of eyes remained clear at 3 years. 
⦁    After adjusting for preservation time, those who received tissue from donors with diabetes were >5 times more likely to experience primary or early failure. 
⦁    Those with operative complications were >4 times more likely to experience this outcome. 
⦁    Patients with PACE before surgery were >12 times more likely to experience late failure, compared to those with Fuchs dystrophy.
⦁    Other factors–including donor age, preoperative donor endothelial cell density, graft diameter, and injector used for graft insertion–appeared to have no impact on early or late failure. 

Terry M. Factors Associated with Graft Success in the Cornea Preservation Time Study. Talk presented at: AAO 2018 annual meeting; October, 26-30, 2018; Chicago.

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