title: Factors affecting DSAEK graft lenticle adhesion: an in vitro experimental study.
abstract: OBJECTIVE
  The aim of this study was to evaluate different factors that affect Descemet stripping automated endothelial keratoplasty (DSAEK) donor graft lenticle adhesion to the recipient cornea.
  
  
  METHODS
  This experimental study included 10 eye bank recipient corneas and 10 donor DSAEK lenticles. Recipient corneas were mounted on an artificial anterior chamber (AC), whereas donor lenticles were placed beneath the host cornea. Using optical coherence tomography and imaging software, the interface gap (IG) between the donor and recipient cornea was quantified to evaluate the effect of variations in AC air fill pressure, AC air fill duration, corneal massage, and corneal venting incisions on DSAEK donor graft lenticle adhesion.
  
  
  RESULTS
  Different intraocular pressures (IOP) under air for the same time intervals, do not significantly correlate with the IG; nevertheless, it was noticed that the IG decreases as the IOP increases. With respect to the magnitude of AC IOP, there was no statistically significant difference when comparing 10 mm Hg with 30 mm Hg and assessing IG (P = 0.4). Complete air-fluid exchange resulted in significantly higher IG when compared with AC air bubble of 10 and 30 mm Hg that was sustained for 1 hour (P < 0.05). Furthermore, corneal surface massage did not facilitate DSAEK graft adhesion (P = 0.59). Finally, paracentral venting incisions followed by interface fluid aspiration seemed to significantly decrease the IG (P = 0.014).
  
  
  CONCLUSIONS
  Corneal venting incisions and higher AC IOP values seem to facilitate DSAEK donor graft lenticle adhesion to the recipient cornea.
authors.affiliation: *Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and †LV Prasad Eye Institute, Hyderabad, India.
authors.forename: Pravin K
authors.initials: PK
authors.lastname: Vaddavalli
authors.forename: Vasilios F
authors.initials: VF
authors.lastname: Diakonis
authors.forename: Ana P
authors.initials: AP
authors.lastname: Canto
authors.forename: Vardhaman P
authors.initials: VP
authors.lastname: Kankariya
authors.forename: Rajeev R
authors.initials: RR
authors.lastname: Pappuru
authors.forename: Marco
authors.initials: M
authors.lastname: Ruggeri
authors.forename: Michael R
authors.initials: MR
authors.lastname: Banitt
authors.forename: George D
authors.initials: GD
authors.lastname: Kymionis
authors.forename: Sonia H
authors.initials: SH
authors.lastname: Yoo
mesh_terms: D000388:Air; D000867:Anterior Chamber / Q000378:metabolism; D003886:Descemet Membrane / Q000378:metabolism*; D057111:Descemet Stripping Endothelial Keratoplasty; D058450:Endotamponade; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D000267:Tissue Adhesions; D014019:Tissue Donors; D041623:Tomography, Optical Coherence