Influence of Preoperative Donor Tissue Characteristics on Graft Dislocation Rate After Descemet Stripping Automated Endothelial Keratoplasty

Abstract

PURPOSE To determine the influence of pre-operative donor tissue characteristics on the graft dislocation rate after Descemet’s stripping automated endothelial keratoplasty (DSAEK). METHODS We retrospectively analyzed associations between donor tissue characteristics and graft dislocation rates for consecutive DSAEK surgeries performed in a four year period at a single institution. RESULTS From June 2007 to June 2011, 64 (18%) of 355 eyes underwent a procedure for graft dislocation. There were no differences in donor age, pre-operative endothelial graft thickness, pre-processing endothelial cell density, change in endothelial cell density after processing, time from death to tissue processing, or time from tissue processing to surgery between eyes that experienced dislocations and those that did not (P>.05 for each). The graft recipient’s corneal disease diagnosis, pre-operative corneal thickness, pre-operative visual acuity, glaucoma status, history of glaucoma surgery, and cataract surgery at the time of DSAEK were not associated with an increased rate of dislocation (P>.05 for each). Recipients who experienced graft dislocation were significantly older (73.6 vs. 70.2 years, P=.03) and more likely to undergo subsequent repeat transplantation (29.7% vs. 10.7%, P<.0001). CONCLUSIONS We found no correlation between any corneal donor tissue characteristic and graft dislocation after DSAEK. Graft dislocation was more common in older recipients. Patients with dislocation had a higher rate of subsequent transplantation.

Effect of Graft Attachment Status and Intraocular Pressure on Descemet Stripping Automated Endothelial Keratoplasty Outcomes in the Cornea Preservation Time Study

“…In fact, there appears to be a dose-response effect for degree of detachment on graft success: grafts that were totally detached conferred an 11-fold increased risk of graft failure, grafts that were attached but required repositioning conferred about a 6-fold increased risk, and partially detached grafts had ~3-fold increased risk of graft failure compared to donors that were not totally or partially detached, or decentered requiring additional surgical intervention. Our findings are similar to those of Hood et al 17 who reported that DSAEK lenticule dislocation was associated with a higher rate of repeat transplantation. We also found that graft dislocation, but not grafts that were partially detached with interface fluid, detrimentally impacted ECD in clear grafts 3 years after surgery.…”

“…2,[13][14][15][16] Donor characteristics that have not been shown to increase the risk for graft dislocation include donor age, death to surgery time, donor lenticule thickness, and post-processing ECD. 14,17 Additionally, recipient characteristics including preoperative corneal thickness, preoperative diagnosis, history of glaucoma or prior glaucoma surgery, 10 and concurrent cataract surgery have not been associated with an increased incidence of graft dislocation. 17 However, other recipient factors such as older age, 17 aphakia, 18,19 presence of an anterior chamber intraocular lens, 18 postoperative hypotony in eyes with prior glaucoma surgery, 15 previous vitrectomy, 20 and concurrent IOL exchange 18 have been associated with graft dislocation.…”

“…14,17 Additionally, recipient characteristics including preoperative corneal thickness, preoperative diagnosis, history of glaucoma or prior glaucoma surgery, 10 and concurrent cataract surgery have not been associated with an increased incidence of graft dislocation. 17 However, other recipient factors such as older age, 17 aphakia, 18,19 presence of an anterior chamber intraocular lens, 18 postoperative hypotony in eyes with prior glaucoma surgery, 15 previous vitrectomy, 20 and concurrent IOL exchange 18 have been associated with graft dislocation. To our knowledge, this is the first report to suggest that tissue from donors with diabetes and greater central donor corneal thickness prior to lamellar dissection are associated with an increased risk of graft dislocation.…”

“…9,10,13 Others define dislocation as those that require another injection of an air bubble to ensure adhesion (vs. only requiring observation) including grafts floating freely. 16 For example, Hood et al 17 defined graft dislocation as the "non-adherence of the donor graft to the recipient requiring surgical intervention with a rebubble technique either in the operating room or in an outpatient procedure room either on the same day or on a subsequent day". Eighteen percent of their transplanted DSAEK lenticules qualified as dislocated using this definition.…”

Porcine endothelial grafts could survive for a long term without using systemic immunosuppressors: An investigation of feasibility and efficacy of xeno‐Descemet's stripping automated endothelial keratoplasty from WZS‐pig to rhesus monkey

“…Of the three aspects, we suppose the most important and challenging aspect is to prepare the grafts. Some authors analyzed the histopathologic features of the failed DSAEK grafts in human and found thick and irregular grafts were more likely to detach from the posterior stromal bed . Considering that, we hired double‐pass rather than single‐pass technique to harvest an appropriate thickness .…”