Preconditioned donor corneal thickness for microthin endothelial keratoplasty.

Abstract

PURPOSE:

To describe a novel surgical technique to produce thin endothelial grafts for Descemet stripping automated endothelial keratoplasty (DSAEK).

METHODS:

Thirteen human cadaveric corneas in organ culture were randomized into conventional (n = 7) and microthin (n = 6) DSAEK groups. Grafts in the conventional DSAEK group were prepared using the conventional DSAEK technique of a single microkeratome pass with a 350-μm cutting head. Corneas in the microthin group were preconditioned to achieve a target central thickness of 530 μm before graft dissection with a 350-μm microkeratome head. Preconditioning involved stromal dehydration under pachymetric control using sterile airflow for 15-second increments. Donor and graft thicknesses were assessed with optical coherence tomography, and endothelial viability with trypan blue and alizarin red staining.

RESULTS:

Mean endothelial graft thickness obtained using the microthin DSAEK technique was 106 μm (SD, 32 μm) compared with 177 μm (SD, 33 μm) obtained using conventional DSAEK technique (P = 0.0024). Donor preconditioning yielded a predicted reduction of 100 μm in graft stromal thickness at a rate of 1.5 μm/s and mean duration of 72 seconds. The average anterior lamella thickness (cut depth) obtained in microthin and conventional DSAEK groups were 424 and 431 μm, respectively (P = 0.84). There was no difference in endothelial viability between the 2 groups. There were no corneal perforations during graft preparation in this study.

CONCLUSIONS:

Donor preconditioning by pachymetry-controlled stromal dehydration achieved significantly thinner endothelial grafts compared with the conventional DSAEK technique without compromise to endothelial viability or graft wastage.

• Authors: Peter B M Thomas, Achyut N Mukherjee, Dominic O'Donovan, Madhavan S Rajan
• Journal: Cornea (Cornea) Vol. 32 Issue 7 Pg. e173-8 (Jul 2013) ISSN: 1536-4798 [Electronic] United States
• PMID: 23665648 (Publication Type: Journal Article, Randomized Controlled Trial)

Topics

• Aged
• Aged, 80 and over
• Corneal Pachymetry
• Corneal Stroma (anatomy & histology)
• Descemet Stripping Endothelial Keratoplasty (methods)
• Desiccation (methods)
• Endothelium, Corneal (anatomy & histology)
• Fuchs' Endothelial Dystrophy (surgery)
• Humans
• Organ Culture Techniques
• Organ Size
• Tissue Donors
• Tissue and Organ Harvesting (methods)
• Tomography, Optical Coherence