Preconditioned donor corneal thickness for microthin endothelial keratoplasty

Area of Science:

• Ophthalmology
• Surgical Innovation
• Corneal Transplantation

Background:

• Descemet stripping automated endothelial keratoplasty (DSAEK) is a common procedure for corneal endothelial dysfunction.
• Current DSAEK techniques can result in grafts of variable thickness, potentially impacting surgical outcomes.
• There is a need for methods to consistently produce thinner, high-quality endothelial grafts.

Purpose of the Study:

• To introduce and evaluate a novel surgical technique for preparing thinner endothelial grafts for DSAEK.
• To compare the thickness and viability of grafts prepared with the new microthin technique versus the conventional DSAEK method.

Main Methods:

• A microthin DSAEK technique involving preconditioning of donor corneas via stromal dehydration under pachymetric control was developed.
• Thirteen human cadaveric corneas were randomized into conventional DSAEK (n=7) and microthin DSAEK (n=6) groups.
• Graft thickness was measured using optical coherence tomography, and endothelial viability was assessed with staining.

Main Results:

• The microthin DSAEK technique yielded significantly thinner grafts (mean 106 μm) compared to conventional DSAEK (mean 177 μm; P = 0.0024).
• Donor preconditioning effectively reduced stromal thickness without affecting endothelial viability.
• No corneal perforations occurred during graft preparation in either group.

Conclusions:

• Pachymetry-controlled stromal dehydration is an effective method for producing significantly thinner endothelial grafts for DSAEK.
• This novel microthin DSAEK technique does not compromise endothelial viability or lead to graft wastage.
• The technique offers a promising advancement for DSAEK procedures.