Graft detachment rates in surgeon-cut and pre-cut tissue for DSAEK transported in different mediums

To analyse graft detachment rates after Descemet stripping automated endothelial keratoplasty (DSAEK) using surgeon-cut grafts and pre-cut grafts transported in different mediums.

A retrospective study of graft detachment rates including 265 surgeries (240 patients) performed between 2019 and 2023. The DSAEK grafts were either surgeon-cut (n = 135) or pre-cut and transported in a dextran-containing medium (n = 82) or in a dextran-free medium (n = 48). All surgeries were performed by a single surgeon (I.G.). The surgeries were categorised according to whether the recipients' eyes had, or did not have, factors associated with an increased risk of graft detachment. Detachment rates were compared for all patients receiving the different kinds of graft, and only for those without risk factors.

A significantly higher detachment rate was found among patients receiving pre-cut grafts transported in a dextran-containing medium (32.9%), compared to surgeon-cut grafts (14.1%, p = 0.002), and pre-cut grafts transported in a dextran-free medium (6.3%, p = 0.002) for all recipients (those with and without risk factors for graft detachment). When analysing recipients without risk factors for graft detachment, the detachment rate was still significantly higher with pre-cut tissue transported in a dextran-containing medium (26.9%), compared to surgeon-cut tissue (8.3%, p = 0.002) and pre-cut tissue transported in a dextran-free medium (3.6%, p = 0.01).

The use of pre-cut DSAEK tissue transported in a dextran-containing medium significantly increases the risk of graft detachment requiring re-bubbling.