title: [Influence of surgical technique on graft and endothelial survival in endothelial keratoplasty].
abstract: OBJECTIVE
  To report survival of the graft and its endothelium after Descemet Stripping Endothelial Keratoplasty (DSEK) in a series of consecutive cases with no exclusion of cases corresponding to the learning curve and to analyze the influence of surgical techniques on survival.
  
  
  METHODS
  This prospective observational study includes 170 consecutive DSEK's performed between 2006 and 2013. The main outcome criteria were graft survival and survival of the donor corneal endothelium as assessed by specular microscopy. The following parameters were analyzed: preoperative diagnosis, lens status, surgical techniques, and graft thickness.
  
  
  RESULTS
  Graft survival was 91.7% at 1 year and 71.5% at 3 years. Graft survival was significantly associated with surgical technique (P=0.04). The best graft survival was achieved with scleral incision combined with graft insertion with the Endosaver® device (dedicated DSEK injector). Graft survival decreased with graft thickness (P<0.001). One-year endothelial cell density was significantly associated with surgical technique (P=0.003). Early 1-year endothelial cell loss was 42.0% for the scleral incision/Endosaver® group, 48.7% for the corneal incision/Endosaver® group, 49.4% for the corneal incision/Busin guide group, 66.0% for the corneal incision/IOL injector group, and 66.7% for the scleral incision/forceps group (P=0.002).
  
  
  CONCLUSIONS
  The success rate of DSEK is close to that of penetrating keratoplasty. The use of a DSEK-dedicated injector results in higher survival of the graft and its endothelium. The use of ultrathin grafts also appears to represent significant progress.
authors.affiliation: CIC 503, CHNO des XV-XX/Inserm/Sorbonne universités, UPMC université Paris 06, 28, rue de Charenton, 75571 Paris cedex 12, France. Electronic address: vincent.borderie@upmc.fr.
authors.forename: V M
authors.initials: VM
authors.lastname: Borderie
authors.affiliation: CIC 503, CHNO des XV-XX/Inserm/Sorbonne universités, UPMC université Paris 06, 28, rue de Charenton, 75571 Paris cedex 12, France.
authors.forename: C
authors.initials: C
authors.lastname: Georgeon
authors.affiliation: CIC 503, CHNO des XV-XX/Inserm/Sorbonne universités, UPMC université Paris 06, 28, rue de Charenton, 75571 Paris cedex 12, France.
authors.forename: N
authors.initials: N
authors.lastname: Bouheraoua
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D057111:Descemet Stripping Endothelial Keratoplasty / Q000295:instrumentation / Q000379:methods*; D042783:Endothelial Cells / Q000166:cytology / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies
keywords: Cornea; Cornée; DSEK; Endothelium; Endothélium; Graft survival; Microscopie spéculaire; OCT; Specular microscopy; Survie du greffon