Document Detail


Randomized, prospective comparison of precut vs surgeon-dissected grafts for descemet stripping automated endothelial keratoplasty.
MedLine Citation:
PMID:  18439566     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To determine whether eye bank predissected corneal grafts provide outcomes comparable to surgeon-dissected grafts for Descemet stripping automated endothelial keratoplasty (DSAEK). DESIGN: Randomized, prospective, double-masked clinical trial. METHODS: Twenty pairs of donor corneas were harvested. One cornea from each pair was randomized to be precut at an eye bank for next-day use. The surgeon dissected the fellow cornea intraoperatively using a comparable microkeratome and protocol. The corneas were randomly assigned to 40 subjects having DSAEK at a single center. Subjects and evaluators were masked and statistical significance was assessed using the paired t test. RESULTS: Mean subject age was 71 +/- 12 years and 90% had Fuchs dystrophy. Mean endothelial cell loss was 32% at six months and 34% at one year; the two groups did not differ by a statistically significant amount at either time point (P = .10 and P = .79, respectively). Each group experienced two early dislocations (10%), and grafts were repositioned successfully with a second air bubble. At six months, 28 of 35 patients (80%) had best-corrected vision of 20/40 or better, excluding five patients (12%) with preexisting retinal problems (P = .48). Both groups experienced a mild hyperopic shift (P = .82), and neither had a statistically significant increase in mean refractive cylinder (P = .63). Histology from one subject's eye postmortem demonstrated that endothelial cells had migrated over the exposed edge of the donor stroma a year after surgery. CONCLUSIONS: Eye bank precut tissue provided similar endothelial cell loss, visual and refractive outcomes, and detachment rates compared with surgeon-dissected tissue.
Authors:
Marianne O Price; Kashif M Baig; Jacob W Brubaker; Francis W Price
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2008-04-24
Journal Detail:
Title:  American journal of ophthalmology     Volume:  146     ISSN:  0002-9394     ISO Abbreviation:  Am. J. Ophthalmol.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-24     Completed Date:  2008-07-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370500     Medline TA:  Am J Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  36-41     Citation Subset:  AIM; IM    
Affiliation:
Cornea Research Foundation of America, 9002 N. Meridian Street, Indianapolis, IN 46260, USA. mprice@cornea.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Cell Count
Corneal Transplantation / methods*
Descemet Membrane / surgery*
Double-Blind Method
Endothelium, Corneal / pathology,  transplantation*
Eye Banks / methods
Female
Fuchs' Endothelial Dystrophy / surgery
Humans
Male
Ophthalmology / methods
Prospective Studies
Refraction, Ocular
Specimen Handling / methods*
Treatment Outcome
Visual Acuity

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


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