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Primary graft failure in preloaded vs surgeon prepared DSAEK: a clinical and ex vivo correlation study
Kamran M Riaz1, Karanpreet S Multani, Liam Redden
1From the Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz, Multani, Redden, O. Mian); Department of Clinical Operations, Eversight, Ann Arbor, Michigan (Szkarlat); Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Ding); Center for Vision and Eye Banking Research, Eversight, Cleveland, Oklahoma (Ludwig, Sawant); Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan (S. Mian).
Purpose:
To evaluate whether primary graft failure (PGF) rates and endothelial cell loss (ECL) differ between surgeon-trephined/loaded and eye bank-preloaded Descemet-stripping automated endothelial keratoplasty (DSAEK) grafts.
Setting:
Tertiary care academic center.
Design:
Retrospective case series and ex vivo laboratory study.
Methods:
Single-center review of 69 eyes undergoing DSAEK (2020-2023) divided into 3 groups based on graft preparation and eye bank source: (1) eye bank-preloaded in EndoSerter (PL-ES), (2) eye bank-preloaded in glass tube (PL-GT), and (3) surgeon-trephined/loaded in EndoSerter (SL-ES). The primary clinical outcome was PGF (persistent corneal edema >3 months despite medical therapy). Secondary outcomes included visual outcomes and clinical complications (cystoid macular edema [CME] and rebubbling rate [RR]). The primary outcome of the laboratory study was percentage ECL (%ECL).
Results:
All lenticules were ≤80 μm. PGF was significantly higher in the PL-ES group (8/20; 40%) and the PL-GT group (4/7; 57%) compared with the SL-ES group (1/42; 2%) ( P < .0001). Grafts requiring rebubbling were more likely to experience PGF ( P = .0176). PGF eyes were regrafted with SL-ES DSAEK; none experienced subsequent PGF. There were no significant differences in CME, RR, corrected distance visual acuity, and spherical equivalent. The ex vivo study included 9 PL-ES, 6 PL-GT, and 6 SL-ES grafts. %ECL was higher in both preloaded groups than SL-ES ( P = .0354), although significance was not demonstrated on post hoc analysis. Fluorescent imaging revealed more cell loss in preloaded grafts.
Conclusions:
Preloading and storage of DSAEK grafts may affect PGF rates clinically and ECL ex vivo.
