Clinical outcomes of DSAEK with pre-cut grafts of thickness more than 150 microns

To study the clinical outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) with pre-cut lenticules of thickness above 150 microns.

During the study period Jan 2019 to Sept 2020, 1865 pre-cut DSAEK lenticules were prepared at the institute-affiliated eye bank by two trained technicians. Of these, 28 (1.5%) grafts had a thickness >150 microns and were utilized at the institute. Retrospective review of medical records was performed for these patients.

Median donor age was 39 (range, 20-62) years, death to preservation time was 6 (range, 0.28-8.4) hours, endothelial cell density (ECD) was 2738 (range, 2203-3788) cells/mm 2 , graft thickness was 186 (range, 170-250) microns. The mean recipient age was 58 (range, 36-76) years, and 17 were males. The most common indication for surgery was pseudophakic corneal edema ( n = 14, 50%). The mean log MAR visual acuity at 1-month, 3-month, and 6-month post-operative visits improved to 0.8, 0.7, and 0.5, respectively. The mean lenticule thickness at 3- and 6-month post-operative period reduced to 161 and 151 microns, respectively. Graft detachment needing rebubbling in 5/28 (17.8%) eyes. Primary graft failure was noted in six (21.4%) eyes, which included one eye that underwent rebubbling. Secondary graft failure was noted in four eyes (14.2%). Eighteen (81.8%. 18/22) eyes were maintained graft clarity till the end of the study period, mean follow-up of 10.5 (range, 3-18) months.

With the currently practiced nomograms in automated methods of DSAEK graft preparation, graft thickness over 150 microns can occur infrequently (<1.5%); however, DSAEK lenticules above150 microns can have a favorable outcome in large majority (81.8%). The study noted rebubbling and primary graft failure rate in a fifth of all eyes with lenticule thickness > 150 microns.