Randomized, prospective comparison of precut vs surgeon-dissected grafts for descemet stripping automated endothelial keratoplasty

Am J Ophthalmol. 2008 Jul;146(1):36-41. doi: 10.1016/j.ajo.2008.02.024. Epub 2008 Apr 24.


Purpose: To determine whether eye bank predissected corneal grafts provide outcomes comparable to surgeon-dissected grafts for Descemet stripping automated endothelial keratoplasty (DSAEK).

Design: Randomized, prospective, double-masked clinical trial.

Methods: Twenty pairs of donor corneas were harvested. One cornea from each pair was randomized to be precut at an eye bank for next-day use. The surgeon dissected the fellow cornea intraoperatively using a comparable microkeratome and protocol. The corneas were randomly assigned to 40 subjects having DSAEK at a single center. Subjects and evaluators were masked and statistical significance was assessed using the paired t test.

Results: Mean subject age was 71 +/- 12 years and 90% had Fuchs dystrophy. Mean endothelial cell loss was 32% at six months and 34% at one year; the two groups did not differ by a statistically significant amount at either time point (P = .10 and P = .79, respectively). Each group experienced two early dislocations (10%), and grafts were repositioned successfully with a second air bubble. At six months, 28 of 35 patients (80%) had best-corrected vision of 20/40 or better, excluding five patients (12%) with preexisting retinal problems (P = .48). Both groups experienced a mild hyperopic shift (P = .82), and neither had a statistically significant increase in mean refractive cylinder (P = .63). Histology from one subject's eye postmortem demonstrated that endothelial cells had migrated over the exposed edge of the donor stroma a year after surgery.

Conclusions: Eye bank precut tissue provided similar endothelial cell loss, visual and refractive outcomes, and detachment rates compared with surgeon-dissected tissue.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cell Count
  • Corneal Transplantation / methods*
  • Descemet Membrane / surgery*
  • Double-Blind Method
  • Endothelium, Corneal / pathology
  • Endothelium, Corneal / transplantation*
  • Eye Banks / methods
  • Female
  • Fuchs' Endothelial Dystrophy / surgery
  • Humans
  • Male
  • Ophthalmology / methods
  • Prospective Studies
  • Refraction, Ocular
  • Specimen Handling / methods*
  • Treatment Outcome
  • Visual Acuity