title: Endothelial keratoplasty: the relationship between donor tissue size and donor endothelial survival.
abstract: OBJECTIVE
  To determine if donor graft diameter has a relationship with postoperative central endothelial cell density (ECD) and survival in Descemet's stripping automated endothelial keratoplasty (DSAEK).
  
  
  METHODS
  Retrospective, comparative analysis of an interventional case series.
  
  
  METHODS
  Three hundred thirty-one eyes of 243 patients undergoing DSAEK surgery for Fuchs' endothelial dystrophy without a history of rejection or graft dislocation.
  
  
  METHODS
  Descemet's stripping automated endothelial keratoplasty was performed in 331 eyes with Fuchs' dystrophy. After exclusion of confounding variables, postoperative ECD and percentage cell loss was compared for 8.0-mm grafts (n = 154) versus 8.5-mm grafts (n = 165) over a 2-year postoperative period.
  
  
  METHODS
  Total central ECD and percentage of donor endothelial cell loss as measured by specular microscopy of central ECD.
  
  
  RESULTS
  Mean preoperative ECD was 2635 cells/mm(2) for 8.0-mm grafts and 2732 cells/mm(2) for 8.5-mm grafts (P = 0.003). Mean ECD (and percent cell loss from before surgery) was 2011 cells/mm(2) (22.9%) for 8.0-mm grafts and 2078 cells/mm(2) (23.5%) for 8.5-mm grafts at 6 months, 2009 cells/mm(2) (23.3%) and 2113 cells/mm(2) (23.1%) at 1 year, and 2060 cells/mm(2) (23.4%) and 2111 cells/mm(2) (24.3%) at 2 years (P>0.72 for percentage cell loss at all time points).
  
  
  CONCLUSIONS
  Descemet's stripping automated endothelial keratoplasty grafts with a diameter of 8.5 mm do not offer a clinical advantage over smaller 8.0-mm grafts for postoperative endothelial cell counts in the first 2 years after surgery.
  
  
  BACKGROUND
  Proprietary or commercial disclosure may be found after the references.
authors.affiliation: Devers Eye Institute, Portland, Oregon; Lions Eye Bank of Oregon Vision Research Laboratory, Portland, OR 97210, USA. mterry@deverseye.org
authors.forename: Mark A
authors.initials: MA
authors.lastname: Terry
authors.forename: Jennifer
authors.initials: J
authors.lastname: Li
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Goshe
authors.forename: David
authors.initials: D
authors.lastname: Davis-Boozer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis*; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors