Pull-Through Insertion Technique for Descemet Stripping Automated Endothelial Keratoplasty (DSAEK): Graft Survival and Endothelial Cell Loss after 1 Year in 100 Eyes

Aim: To assess graft survival and endothelial cell loss after DSAEK using a pull-through insertion technique with incision width of 3.2mm or 4.1mm. Methods: The medical records of 100 consecutive eyes that had undergone DSAEK at the Turin University Ophthalmology Institute between November 2007 and April 2010 were reviewed. Surgery was performed by a single surgeon and included: descemethorexis, insertion of a 8.00-9.00mm microkeratome-prepared lamella using a Busin glide, and air injection in the anterior chamber. The lamellas were inserted through a 3.2mm incision in the first 46 eyes, and through a 4.1mm incision in the subsequent 54 eyes. Graft survival, endothelial-cell loss, visual recovery and complications were assessed one year after surgery. Results: DSAEK surgery was performed in 87 patients with mean age 72±12 years. Cornea guttata was the most common preoperative diagnosis (58%). One year after surgery, graft survival was 95%: 91% and 98%, respectively, in eyes with 3.2mm and 4.1mm incision, the difference not being statistically significant (p=0.11). Mean endothelialcell loss was 37±12%. Endothelial-cell loss was significantly higher in eyes in which donor tissue had been inserted through a 3.2mm corneal incision (39±15% versus 32±10%; p<0.001). In eyes without comorbidities, CDVA was ≥0.5 in 91% of cases, and ≥0.8 in 52%. The most common complication was posterior lamella detachment, which occurred in 14 eyes (14%); incidence decreased progressively: 6% in the more recent 50 interventions. Conclusion: After DSAEK with pull-through insertion technique, one-year graft survival rates were high. Graft survival was comparable in eyes in which donor tissue was inserted through 3.2mm and 4.1mm incisions. However, the wider incision lead to lower postoperative endothelial-cell loss. *Corresponding author: Ugo de Sanctis, Assistant Professor, Department of Clinical Physiopathology, Ophthalmology Institute, University of Turin, Via Juvarra 19, Turin, Italy, Tel: 0039 11 5666032; Fax 0039 11 539024; E-mail: ugo. [email protected] Received November 13, 2011; Accepted December 21, 2011; Published December 26, 2011 Citation: de Sanctis U, Aragno V, Brusasco L, Damiani F, Grignolo F (2011) Pull-Through Insertion Technique for Descemet Stripping Automated Endothelial Keratoplasty (DSAEK): Graft Survival and Endothelial Cell Loss after 1 Year in 100 Eyes. J Transplant Technol Res S2:003. doi:10.4172/2161-0991.S2-003 Copyright: © 2011 de Sanctis U, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.