Descemet’s Stripping with Endothelial Keratoplasty: Comparative Outcomes with Microkeratome-Dissected and Manually Dissected Donor Tissue
Presented at: American Academy of Ophthalmology Meeting, October 2005, Chicago, Illinois.
Received 15 December 2005; accepted 26 May 2006. published online 25 August 2006.
Purpose
To compare outcomes with 2 donor dissection methods for Descemet’s stripping with endothelial keratoplasty (DSEK).
Design
Retrospective, comparative, nonrandomized case series.
Participants
Three hundred thirty consecutive transplants, 114 with manually dissected and 216 with microkeratome-dissected donor tissue.
Methods
Donor posterior stroma/endothelium was transplanted, after stripping recipient Descemet’s membrane/endothelium and dissecting the donor tissue by hand or with a microkeratome.
Main Outcome Measures
Incidences of donor perforation and donor detachment were compared for all eyes. Visual and refractive outcomes were compared for the first 100 consecutive eyes in each group.
Results
Visual recovery was faster with microkeratome-dissected donor tissue, as evidenced by statistically better best spectacle-corrected visual acuity (VA) in that group 1 month after surgery (P = 0.015). Best spectacle-corrected VA was statistically comparable for the 2 groups preoperatively and 3 and 6 months postoperatively. Best spectacle-corrected VA was not correlated significantly with postoperative central corneal thickness (P = 0.25). Corneal thickness was significantly higher in the microkeratome group (690±77 μm, compared with 610±62 μm after hand dissection; P<0.0001). Mean refractive astigmatism was 1.5 diopters (D) preoperatively and 6 months postoperatively in both groups. Spherical equivalent refraction did not change in the microkeratome group (P = 0.64) but increased by 0.66 D in the hand dissection group (P = 0.0007). Methods designed to remove fluid from the donor/recipient graft interface ultimately reduced the detachment rate to <1% (1 in the last 140 cases). No donor perforations occurred in 216 microkeratome dissections, compared with 5 in 114 hand dissections (P = 0.002).
Conclusions
Microkeratome dissection reduced the risk of donor tissue perforation, provided faster visual recovery after DSEK, and did not alter the refractive outcome.
1Cornea Research Foundation of America, Indianapolis, Indiana.
Reprint requests to Marianne O. Price, Cornea Research Foundation of America, 9002 North Meridian Street, Suite 212, Indianapolis, IN 46260.
Manuscript no. 2005-1223.
1 Dr Francis Price has received travel grants from Moria (Antony, France) and is a consultant for Alcon (Fort Worth, Texas) and Allergan Inc. (Irvine, California).
ABSTRACT