title: Descemet's stripping with endothelial keratoplasty: comparative outcomes with microkeratome-dissected and manually dissected donor tissue.
abstract: OBJECTIVE
  To compare outcomes with 2 donor dissection methods for Descemet's stripping with endothelial keratoplasty (DSEK).
  
  
  METHODS
  Retrospective, comparative, nonrandomized case series.
  
  
  METHODS
  Three hundred thirty consecutive transplants, 114 with manually dissected and 216 with microkeratome-dissected donor tissue.
  
  
  METHODS
  Donor posterior stroma/endothelium was transplanted, after stripping recipient Descemet's membrane/endothelium and dissecting the donor tissue by hand or with a microkeratome.
  
  
  METHODS
  Incidences of donor perforation and donor detachment were compared for all eyes. Visual and refractive outcomes were compared for the first 100 consecutive eyes in each group.
  
  
  RESULTS
  Visual recovery was faster with microkeratome-dissected donor tissue, as evidenced by statistically better best spectacle-corrected visual acuity (VA) in that group 1 month after surgery (P = 0.015). Best spectacle-corrected VA was statistically comparable for the 2 groups preoperatively and 3 and 6 months postoperatively. Best spectacle-corrected VA was not correlated significantly with postoperative central corneal thickness (P = 0.25). Corneal thickness was significantly higher in the microkeratome group (690+/-77 mum, compared with 610+/-62 mum after hand dissection; P<0.0001). Mean refractive astigmatism was 1.5 diopters (D) preoperatively and 6 months postoperatively in both groups. Spherical equivalent refraction did not change in the microkeratome group (P = 0.64) but increased by 0.66 D in the hand dissection group (P = 0.0007). Methods designed to remove fluid from the donor/recipient graft interface ultimately reduced the detachment rate to <1% (1 in the last 140 cases). No donor perforations occurred in 216 microkeratome dissections, compared with 5 in 114 hand dissections (P = 0.002).
  
  
  CONCLUSIONS
  Microkeratome dissection reduced the risk of donor tissue perforation, provided faster visual recovery after DSEK, and did not alter the refractive outcome.
authors.affiliation: Cornea Research Foundation of America, Indianapolis, Indiana, USA. mprice@cornea.org
authors.forename: Marianne O
authors.initials: MO
authors.lastname: Price
authors.forename: Francis W
authors.initials: FW
authors.lastname: Price
mesh_terms: D000368:Aged; D003315:Cornea / Q000601:surgery*; D016039:Corneal Transplantation / Q000009:adverse effects / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery*; D004210:Dissection / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D004728:Endothelium, Corneal / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D020127:Recovery of Function; D012029:Refraction, Ocular; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014785:Vision, Ocular