predictors of endothelial cell density of corneal grafts after dsaek

purpose: to evaluate endothelial cell density (ecd) and morphology of clear corneal grafts after descemet stripping automated endothelial keratoplasty (dsaek) and to determine the factors that influence graft ecd postoperatively. methods: seventy-seven eyes (38 right eyes) of 64 patients (34 female subjects) who underwent dsaek for fuchs’ endothelial dystrophy (n=38) or pseudophakic bullous keratopathy (n=39) were enrolled. precut donor corneas were punched from the endothelial side using a trephine. the donor lamella was inserted into the anterior chamber using the pull-through technique with a busin glide and forceps through a 5-mm clear cornea incision. in eyes with significant lens opacity, dsaek was combined with cataract surgery. confocal microscopy was performed at the final follow up examination to evaluate endothelial cell count and morphology as well as central graft thickness. univariate analyses and multiple linear regression analyses were used to investigate recipient-, donor-, surgical-, and postoperative-related variables capable of influencing graft endothelial counts after dsaek. results: mean age at the time of surgery was 62.3±15.6 years, and the patients were followed for 26.2±20.9 months postoperatively. forty-six eyes (59.7%) underwent stand-alone dsaek, whereas 31 eyes (40.3%) received dsaek combined with cataract surgery. donor trephination size was 8.0±0.21 mm, ranging from 7.50 to 8.25 mm. mean donor age was 30.4±11.2 years and preoperative endothelial cell density was 3127.4±315.1 cells/mm2 which reduced to 1788.6±716.5 cells/mm2 postoperatively (p<0.001). mean postoperative central graft thickness was 102.4±31.6 µm. in the univariate analysis, postoperative ecd was significantly associated with death-to-preservation time (r=-0.31, p=0.046), central graft thickness (r=0.36, p=0.016), follow-up period (r=-0.56, p=0.005), and lenticule non-attachment (r=-0.31, p=0.049). multiple regression analyses identified lenticule thickness (β=10.62, p=0.003) and follow-up period (β=-22.09, p=0.001) as the statistically significant characteristics influencing postoperative ecd. conclusion: the main predictors of ecd after dsaek were central graft thickness and the length of follow-up. surgeons’ requests for ultrathin dsaek donor grafts with the hope of improving visual outcomes may not have the desired outcome with respect to the postoperative ecd.