Hydrated Dextran-Free Donor Tissue: Perfect Graft for Ultra-Thin DSAEK
Narrative Responses:
Purpose
To describe the technique and report the outcomes of a new method of graft preservation and preparation for Descemet stripping automated endothelial keratoplasty (DSAEK), and compare it to the standard technique.
Methods
Forty patients undergoing DSAEK were enrolled in this study. All patients were operated on with the standard technique with the following modifications: 1.Grafts were preserved at the eye bank in organ culture, but Dextran was not added to the medium before shipment, so that donor tissues remained hydrated. 2.Graft preparation was performed using a double-pass of the microkeratome, the first with the 300-µm, the second with the 200-µm head. Graft thickness, best-corrected visual acuity (BCVA), and endothelial cell loss (ECL) were measured prospectively, and retrospectively compared with a cohort of Ultra-Thin DSAEK patients (n=25) treated at the same center.
Results
No donor tissues were lost during preparation in either group. Over the first three months after DSAEK, thickness decreased more in the study group than in the control group (49%±9% vs. 24%±12%, p=.0001). Final graft thickness was lower in the study group averaging 63±25 mm compared to 85±36 mm in the control group (p=.003). Six month after DSAEK, BCVA was ≥20/20 in 53% eyes in the study group and 32% in the control group, after excluding eyes with vision-limiting comorbidities. This difference was not statistically significant. ECL at six months was also not significantly different between groups (32% vs. 33%).
Conclusion
Avoiding preoperative osmotic donor tissue dehydration allows the preparation of DSAEK grafts that actively halve their thickness after surgery. Dextran–free preparation of DSAEK grafts effectively reduces final graft thickness without increasing surgical difficulty and rate of tissue-loss. Use of hydrated tissue may optimize graft preparation for DSAEK.