Comparison of Visual Outcomes Using Ultrathin Versus Standard-Thickness Endothelial Grafts
Narrative Responses:
Purpose
To compare the visual results, safety and complications of a prospective study of 2 groups of patients undergoing endothelial transplants (DSAEK) using either Ultrathin or Standard thickness donors.
Methods
All surgeries were performed by 3 cornea specialists (TP, EC, ED). Patients were randomly assigned to 2 groups: Group 1 consisted of Ultrathin donors whose thickness ranged from 30 – 99u. Group 2 received donors of 100u or greater (standard thickness). Group 1 donors were precut at the eyebank. Group 2 standard thickness donors were cut by the surgeons at the time of surgery,using the Moria microkeratome and artificial anterior chamber. Inclusion criteria for both groups consisted of patients with Fuchs’ and Posterior Polymorphous Dystrophy, pseudophakic bullous keratopathy, and failed penetrating keratoplasty. Patients with evidence of posterior segment disease were excluded.
Results
Mean Log BSCVA was better in the Ultrathin group than the standard thickness group at 1 month (20/38 vs 20/52) 3months (20/33 vs 20/42), 6 months (20/33 vs 20/38) and 12 month (20/28 vs 20/35) post op intervals. The percentage of patients achieving better than or equal to 20/40, 20/30 and 20/25 vision postop was greater at all post op intervals for patients receiving Ultrathin as compared to Standard thickness donors. Graft failure and rejection rates were comparable for both groups. Re-bubble rate was greater in the ultrathin group than the standard thickness group, and was higher for corneal fellows performing their first cases.
Conclusion
Patients receiving ultrathin grafts achieved better vision than patients receiving standard thickness grafts at 1, 3, 6 and 12 months post op. Complications were comparable for both groups. Ultrathin and standard thickness DSAEK surgery is safe and effective, and provides significant visual rehabilitation for patients with endothelial disease.