title: Clinical outcomes in descemet stripping automated endothelial keratoplasty with internationally shipped precut donor corneas.
abstract: OBJECTIVE
  To report the endothelial cell loss and clinical outcomes in Descemet stripping automated endothelial keratoplasty (DSAEK) with internationally shipped, precut donor corneas.
  
  
  METHODS
  Retrospective analysis of a noncomparative case series.
  
  
  METHODS
  The setting was a single hospital. The clinical results of 134 eyes of 128 patients who underwent DSAEK in Kyoto, Japan, with internationally shipped precut donor corneas from Portland, Oregon, or Seattle, Washington, were evaluated. In addition, 40 precut donor corneas from Seattle were evaluated in respect to the postprecut international shipment-related loss of corneal endothelial cell density (ECD). Observation procedures were noncontact specular microscopy. The main outcome measures were the evaluation of international shipment-related ECD loss, postoperative ECD, visual recovery, and complications.
  
  
  RESULTS
  The mean postprecut ECD loss in 40 donor corneas during international shipment was 2.3%. The mean elapsed time from cut to surgery was 63.2 ± 31.1 hours. At 6, 12, 24, and 36 months postoperatively, the mean ECD of the internationally shipped donor corneas was 2038, 1933, 1670, and 1431 cells/mm(2), respectively. The mean ECD loss at 6, 12, 24, 36 months after DSAEK was 30%, 34%, 44%, and 51%, respectively. Preoperative logarithm of the minimum angle of resolution (logMAR) best spectacle-corrected visual acuity was 1.40 ± 0.55, and at 12 months after DSAEK was 0.22 ± 0.19. Complications included graft dislocation in 12 eyes (8.9%) and graft rejection in 3 eyes (2.2%).
  
  
  CONCLUSIONS
  The present study shows that the outcomes of DSAEK with internationally shipped precut donor corneas were acceptable and that the additional endothelial cell loss associated with international shipment was minimal and did not affect the clinical results.
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: hirokoad@koto.kpu-m.ac.jp.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Nakagawa
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inatomi
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Hieda
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Sotozono
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Yokoi
authors.affiliation: The SightLife Eye Bank, Seattle, Washington, USA.
authors.forename: Bernardino
authors.initials: B
authors.lastname: Iliakis
authors.affiliation: The SightLife Eye Bank, Seattle, Washington, USA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Miller
authors.affiliation: The SightLife Eye Bank, Seattle, Washington, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Ulrickson
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis*; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology*; D005125:Eye Banks; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D038622:Internationality; D007564:Japan; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D014481:United States; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult