title: Outcomes of descemet stripping automated endothelial keratoplasty using imported donor corneas.
abstract: BACKGROUND
  The lack of development of local donor tissue acquisition in several regions of the world has resulted in the necessity of performing keratoplasty with imported donor corneas. The greatest concern about the use of donor corneas supplied by foreign eye banks is the effect of the increased donor death-to-operation time which inevitably occurs during the tissue recovery, tissue processing, and tissue transfer between the countries. The purpose of this study was to report the outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) using imported donor corneas.
  
  
  METHODS
  This retrospective, non-comparative case series investigated the outcomes of the 102 consecutive DSAEK procedures using imported donor corneas performed at a single university-based hospital between August 2006-2014. The main outcome measures were postoperative best-corrected visual acuity (BCVA), endothelial cell density (ECD), and complications.
  
  
  RESULTS
  The mean death-to-operation time was 9.52 ± 1.48 days (range, 8-13). The mean preoperative ECD was 2761 ± 285 cells/mm2. Fuchs' endothelial dystrophy was the predominant indication for grafting. The mean follow-up duration was 65.3 months. Ninety-three eyes had improved vision postoperatively (91.18%). BCVA unchanged in 3 eyes due to preexisting macular scar and advanced glaucoma. Primary graft failure occurred in 6 eyes (5.88%). Of the 93 eyes with improved BCVA, 100% had their best corrected vision within the first 1 year. The mean ECD at 6, 12, 24, 36, and 60 months after surgery was 1762 ± 294 cells/mm2, 1681 ± 284 cells/mm2, 1579 ± 209 cells/mm2, 1389 ± 273 cells/mm2, and 1251 ± 264 cells/mm2respectively. The mean ECD loss at 6 months, 1 year, 2 years, 3 years, and 5 years after surgery was 36.2%, 39.1%, 42.8%, 49.7%, and 54.7% respectively. The most common complication was graft detachment/dislocation (10.78%). There were no cases of any postoperative infection.
  
  
  CONCLUSIONS
  DSAEK with imported donor corneas provides rapid and good visual rehabilitation. The percentages of endothelial cell loss were comparable to those achieved in Western series using domestic corneas in which fresher tissues were available for transplantation.
authors.affiliation: Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Rama VI Rd., Rajathevi, Bangkok, 10400, Thailand. lekhanont@yahoo.com.
authors.forename: Kaevalin
authors.identifier: http://orcid.org/0000-0003-2292-4581
authors.initials: K
authors.lastname: Lekhanont
authors.affiliation: Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Rama VI Rd., Rajathevi, Bangkok, 10400, Thailand.
authors.forename: Kavin
authors.initials: K
authors.lastname: Vanikieti
authors.affiliation: Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Rama VI Rd., Rajathevi, Bangkok, 10400, Thailand.
authors.forename: Nutthida
authors.initials: N
authors.lastname: Nimvorapun
authors.affiliation: Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Rama VI Rd., Rajathevi, Bangkok, 10400, Thailand.
authors.forename: Varintorn
authors.initials: V
authors.lastname: Chuckpaiwong
mesh_terms: D000328:Adult; D000368:Aged; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000379:methods*; D014792:Visual Acuity; D055815:Young Adult
keywords: Descemet stripping automated endothelial keratoplasty; Imported donor corneas; Outcomes