Relationship Between Donor Graft Cell Count and Visual Outcome in DSAEK Patients

Authors

Silvin Bakalian MD PhD, Johanna Choremis MD FRCSC,Michele Mabon MD FRCSC

The authors have no financial interests to disclose

Descemet stripping automated endothelial keratoplasty (DSAEK) has become the preferred surgical treatment of choice for corneal endothelial disorders including Fuch’s endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK)(1)

Studies showed that there is a gradual improvement of visual acuity over time after DSAEK surgery for patients with FED and PBK(2-3)

A study performed by Terry reported no correlation between pre-operative endothelial cell counts and postoperative complications(4)

Introduction

The aim of this study is to determine if there is any correlation between donor graft endothelial cell counts (ECCs) and postoperative visual outcome for FED and PBK patients, who underwent DSAEK surgery

In addition, to evaluate if there is any effect on graft dislocation and survival rate

Purpose

Retrospective interventional case series from a tertiary referral surgical center

A total of 68 consecutive eyes that underwent a DSAEK surgery with a follow up of one year were included in the study

Two different surgeons using the same technique participated in the study

The patients were divided into three different groups based on their donor graft ECCs

Materials & Methods

Group one was comprised from patients who received donor grafts with cell count less than 2500 cells

Group two was comprised from patients who received donor grafts with cell count that varied between 2501-3000 cells

Group three was comprised from patients who received donor grafts with cell count more than 3000 cells

Materials & Methods

The visual acuity (VA) was evaluated in all patients preoperatively, at 3, 6 and 12 months postoperatively

Clinical data including, donor age, recipient age, gender, eye, clinical diagnosis, incision size were recorded

In addition, intraoperative and postoperative complications were noted

The relationship between donor graft ECCs and visual acuity was assessed between the groups of patients

Materials & Methods

Number of cases Group 117 cases

Group 239 cases

Group 312 cases

Number of patients

17 39 12

Mean age of recipient

75 74 71

Mean age of graft donor

64 61 60

Mean endothelial cell count of graft donor

2335 2689 3223

Rebubbing 0% 2 (5.13 %) 0%

Graft survival 100% 100% 100%

Results

Clinicopathological data

Visual Acquity (VA)Log MAR

Group 1<2500 cells

Group 22501-3000

Group 3>3000 cells

Preoperative VA 0,48 0,52 0,6

Postoperative VA at 3 months

0,29 0,30 0,32

Postoperative VA at 6 months

0,29 0,28 0,34

Postoperative VA at 1 year

0,22 0,27 0,22

Results

The mean visual acuity for all groups of patients

Our results showed that there was statistically significant improvement in visual acuity after DSAEK for all groups of patients

This was in concordance with other studies (2-3) In addition, our results demonstrated that there was

no statistically significant differences in visual acuity at different time periods between the different groups of patients with different donor ECCs

Our results also showed that grafts with acceptable ECCs did not affect the postoperative complication rates

Discussion

Our results suggest that donor graft with different acceptable endothelial cell counts did not affect the visual outcome of Descemet striping automated endothelial keratoplasty patients at different intervals up to one year postoperatively

Further studies with longer follow ups and postoperative cell counts are warranted to elucidate if there is a correlation between donor graft endothelial cell counts and visual outcome

Conclusion

1. Price MO, Price FW. Descemet's stripping endothelial keratoplasty. Curr Opin Ophthalmol. 2007;18(4):290–294.

2. Li JY, Terry MA, Goshe J, et al. Three-year visual acuity outcomes after Descemet's stripping automated endothelial keratoplasty. Ophthalmology. 2012 Jun;119(6):1126-9.

3. Phillips PM, Phillips LJ, Much JW, et al. Descemet stripping endothelial keratoplasty: six-month results of the first 100 consecutive surgeries performed solo by a surgeon using 1 technique with 100% follow-up. Cornea. 2012 Dec;31(12):1361-4.

4. Terry MA, Shamie N, Chen ES, et al. Endothelial keratoplasty: the influence of preoperative donor endothelial cell densities on dislocation, primary graft failure, and 1-year cell counts. Cornea. 2008;27:1131–1137.

References