title: Influence of graft size on graft survival following Descemet stripping automated endothelial keratoplasty.
abstract: OBJECTIVE
  To evaluate graft size on outcome following Descemet stripping automated endothelial keratoplasty (DSAEK) METHODS: Consecutive patients who had undergone a DSAEK for Fuchs endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK) with at least 1 year of follow-up. Patients were divided into three groups according to the size of the donor trephine: <9, 9 and 9.5 mm. Main outcomes were postoperative best corrected visual acuity (BCVA) and graft failure. Grafts were prepared using an automated microkeratome. For larger grafts (≥9 mm), a manual dissection of the residual peripheral ring of anterior lamella was performed before trephination. Donor age, endothelial cell density (ECD) and postmortem times; recipient details including risk factors, comorbidity, surgical complications and postoperative BCVA and graft survival were analysed.
  
  
  RESULTS
  Of 174 patients, 131 were included: 84 (64%) with FED and 47 (36%) with PBK. Mean preoperative and postoperative BCVA were 1.01±0.76 and 0.2±0.2 logMAR, respectively, at 12 months with 80.5% achieving 20/40 or better. Postoperative BCVA was significantly associated with ECD (p=0.005), PBK or FED (p=0.004), risk factors (p=0.007) and comorbidity (p=0.016). Eleven patients (8.40%) experienced endothelial graft failure; 17.86% for <9 mm, 7.69% for 9 mm and 3.84% for 9.5 mm trephine sized grafts. Graft failure was significantly associated with ECD (p=0.039) and graft trephine size (p=0.04).
  
  
  CONCLUSIONS
  Larger grafts occupy a smaller chord length in the eye than the trephine size and are expected to provide 10%-20% more endothelial cells. Increased graft size and donor ECD is significantly associated with a reduced graft failure rate.
authors.affiliation: Department of Corneal and External Eye Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Vito
authors.initials: V
authors.lastname: Romano
authors.affiliation: Department of Corneal and External Eye Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Tey
authors.affiliation: Department of Eye and Vision Science, University of Liverpool, Liverpool, UK.
authors.forename: Natalie M E
authors.initials: NM
authors.lastname: Hill
authors.affiliation: Department of Corneal and External Eye Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK Department of Eye and Vision Science, University of Liverpool, Liverpool, UK.
authors.forename: Sajjad
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Department of Corneal and External Eye Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Britten
authors.affiliation: Department of Corneal and External Eye Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Batterbury
authors.affiliation: Department of Corneal and External Eye Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK Department of Eye and Vision Science, University of Liverpool, Liverpool, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Willoughby
authors.affiliation: Department of Corneal and External Eye Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK Department of Eye and Vision Science, University of Liverpool, Liverpool, UK.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kaye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000869:Anterior Eye Segment / Q000473:pathology; D001768:Blister / Q000601:surgery; D055954:Corneal Endothelial Cell Loss / Q000503:physiopathology*; D003886:Descemet Membrane / Q000473:pathology*; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology*; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D009929:Organ Size; D014019:Tissue Donors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
keywords: Cornea