Effect of incision width on graft survival and endothelial cell loss after Descemet stripping automated endothelial keratoplasty

Cornea. 2010 May;29(5):523-7. doi: 10.1097/ICO.0b013e3181c11e5d.


Purpose: To assess the effect of incision width (5.0 and 3.2 mm) on graft survival and endothelial cell loss 6 months and 1 year after Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods: One hundred sixty-seven subjects with endothelial decompensation from a moderate-risk condition (principally Fuchs dystrophy or pseudophakic corneal edema) underwent DSAEK by 2 experienced surgeons. The donor was folded over and inserted with single-point fixation forceps. This retrospective analysis assessed graft survival, complications, and endothelial cell loss, which was calculated from baseline donor and 6-month and 1-year postoperative central endothelial images evaluated by an independent specular microscopy reading center.

Results: No primary graft failures occurred in either group. One-year graft survival rates were comparable (98% vs 97%) in the 5.0- and 3.2-mm groups, respectively (P = 1.0). Complications included graft dislocation, graft rejection episodes, and elevated intraocular pressure and occurred at similar rates in both groups (P > or = 0.28). Pupillary block glaucoma did not occur in either group. Mean baseline donor endothelial cell density did not differ: 2782 cells per square millimeter in the 5.0-mm (n = 64) and 2784 cells per square millimeter in the 3.2-mm (n = 103) groups. Percent endothelial cell loss was 27% +/- 20% (n = 55) versus 40% +/- 22% (n = 71; 6 months) and 31% +/- 19% (n = 45) versus 44% +/- 22% (n = 62; 12 months) in the 5.0- and 3.2-mm incision groups, respectively (both P < 0.001).

Conclusions: One year after DSAEK, overall graft success was comparable for the 2 groups; however, the 5.0-mm incision width resulted in substantially lower endothelial cell loss at 6 and 12 months.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cell Count
  • Corneal Edema / surgery
  • Corneal Endothelial Cell Loss / diagnosis
  • Corneal Endothelial Cell Loss / etiology*
  • Descemet Stripping Endothelial Keratoplasty / methods*
  • Endothelium, Corneal / pathology
  • Female
  • Follow-Up Studies
  • Fuchs' Endothelial Dystrophy / surgery
  • Graft Survival*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Retrospective Studies
  • Tissue Donors
  • Visual Acuity / physiology