Document Detail

Descemet's stripping automated endothelial keratoplasty (DSAEK) using corneal donor tissue not acceptable for use in penetrating keratoplasty as a result of anterior stromal scars, pterygia, and previous corneal refractive surgical procedures.
MedLine Citation:
PMID:  19654530     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The purpose of this study was to evaluate outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) using anterior stromal flawed (ASF) donor corneas that were unsuitable for use in full-thickness penetrating keratoplasty as a result of stromal scars, pterygia, or previous corneal refractive surgery and to compare results with DSAEK using standard tissue.
METHODS: We conducted a review of our initial 42 (19 with 6-month follow up) consecutive DSAEK surgeries using ASF tissue compared with 357 (199 with 6-month follow up) time-matched controls using standard tissue. Intraoperative and perioperative complications, including dislocations and primary graft failures, were compared. Six-month best spectacle-corrected vision, incidence of rejection episodes, postoperative refractive astigmatism, keratometric values, pre- and postoperative topography-derived surface asymmetry index, and surface regularity index were compared.
RESULTS: One surgeon-cut ASF tissue was perforated before surgery and was discarded. No surgeon-cut standard tissue was perforated. No intraoperative complications and no episodes of primary graft failure or pupillary block glaucoma occurred in either group. One (2.4%) postoperative graft dislocation and one (5.2%) graft rejection episode occurred in the study group. There were 10 (2.8%) dislocations and 8 (2.2%) graft rejection in the controls. A statistically similar significant improvement in best spectacle-corrected vision occurred in both groups. Corneal topography, pachymetry, and manifest astigmatism were not significantly different between groups.
CONCLUSION: Postoperative results of DSAEK using donor tissue excluded from use in penetrating keratoplasty as a result of stromal flaws are equivalent to results using standard donor tissue. Central corneal thickness measurements should be performed before cutting to avoid tissue perforation. The use of ASF tissue for DSAEK will expand the cornea donor pool.
Paul M Phillips; Mark A Terry; Neda Shamie; Edwin S Chen; Karen L Hoar; Chris Stoeger; Daniel J Friend; Hisham A Saad
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Cornea     Volume:  28     ISSN:  1536-4798     ISO Abbreviation:  Cornea     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-25     Completed Date:  2009-10-29     Revised Date:  2011-09-21    
Medline Journal Info:
Nlm Unique ID:  8216186     Medline TA:  Cornea     Country:  United States    
Other Details:
Languages:  eng     Pagination:  871-6     Citation Subset:  IM    
Devers Eye Institute, Portland, OR 97210, USA.
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MeSH Terms
Aged, 80 and over
Cicatrix / pathology*
Cornea / pathology*
Corneal Stroma / pathology
Corneal Transplantation* / methods
Descemet Membrane / surgery*
Donor Selection*
Endothelium, Corneal / transplantation*
Follow-Up Studies
Graft Rejection / epidemiology
Keratoplasty, Penetrating*
Medical Records
Middle Aged
Postoperative Complications / epidemiology
Pterygium / pathology*
Refractive Surgical Procedures
Tissue and Organ Harvesting
Treatment Outcome
Visual Acuity
Comment In:
Cornea. 2011 Sep;30(9):1061-2; author reply 1062   [PMID:  21716101 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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