Randomized, prospective comparison of precut vs surgeon-dissected grafts for descemet stripping automated endothelial keratoplasty.
OBJECTIVE
To determine whether eye bank predissected corneal grafts provide outcomes comparable to surgeon-dissected grafts for Descemet stripping automated endothelial keratoplasty (DSAEK).


METHODS
Randomized, prospective, double-masked clinical trial.


METHODS
Twenty pairs of donor corneas were harvested. One cornea from each pair was randomized to be precut at an eye bank for next-day use. The surgeon dissected the fellow cornea intraoperatively using a comparable microkeratome and protocol. The corneas were randomly assigned to 40 subjects having DSAEK at a single center. Subjects and evaluators were masked and statistical significance was assessed using the paired t test.


RESULTS
Mean subject age was 71 +/- 12 years and 90% had Fuchs dystrophy. Mean endothelial cell loss was 32% at six months and 34% at one year; the two groups did not differ by a statistically significant amount at either time point (P = .10 and P = .79, respectively). Each group experienced two early dislocations (10%), and grafts were repositioned successfully with a second air bubble. At six months, 28 of 35 patients (80%) had best-corrected vision of 20/40 or better, excluding five patients (12%) with preexisting retinal problems (P = .48). Both groups experienced a mild hyperopic shift (P = .82), and neither had a statistically significant increase in mean refractive cylinder (P = .63). Histology from one subject's eye postmortem demonstrated that endothelial cells had migrated over the exposed edge of the donor stroma a year after surgery.


CONCLUSIONS
Eye bank precut tissue provided similar endothelial cell loss, visual and refractive outcomes, and detachment rates compared with surgeon-dissected tissue.
Price
Marianne O
MO
Cornea Research Foundation of America, 9002 N. Meridian Street, Indianapolis, IN 46260, USA. mprice@cornea.org
Baig
Kashif M
KM
Brubaker
Jacob W
JW
Price
Francis W
FW
D000368:Aged; D002452:Cell Count; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery*; D004311:Double-Blind Method; D004728:Endothelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005125:Eye Banks / Q000379:methods; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006801:Humans; D008297:Male; D009885:Ophthalmology / Q000379:methods; D011446:Prospective Studies; D012029:Refraction, Ocular; D013048:Specimen Handling / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity