Endothelial keratoplasty: the relationship between donor tissue size and donor endothelial survival

Ophthalmology. 2011 Oct;118(10):1944-9. doi: 10.1016/j.ophtha.2011.02.023. Epub 2011 Jun 8.


Purpose: To determine if donor graft diameter has a relationship with postoperative central endothelial cell density (ECD) and survival in Descemet's stripping automated endothelial keratoplasty (DSAEK).

Design: Retrospective, comparative analysis of an interventional case series.

Participants: Three hundred thirty-one eyes of 243 patients undergoing DSAEK surgery for Fuchs' endothelial dystrophy without a history of rejection or graft dislocation.

Methods: Descemet's stripping automated endothelial keratoplasty was performed in 331 eyes with Fuchs' dystrophy. After exclusion of confounding variables, postoperative ECD and percentage cell loss was compared for 8.0-mm grafts (n = 154) versus 8.5-mm grafts (n = 165) over a 2-year postoperative period.

Main outcome measures: Total central ECD and percentage of donor endothelial cell loss as measured by specular microscopy of central ECD.

Results: Mean preoperative ECD was 2635 cells/mm(2) for 8.0-mm grafts and 2732 cells/mm(2) for 8.5-mm grafts (P = 0.003). Mean ECD (and percent cell loss from before surgery) was 2011 cells/mm(2) (22.9%) for 8.0-mm grafts and 2078 cells/mm(2) (23.5%) for 8.5-mm grafts at 6 months, 2009 cells/mm(2) (23.3%) and 2113 cells/mm(2) (23.1%) at 1 year, and 2060 cells/mm(2) (23.4%) and 2111 cells/mm(2) (24.3%) at 2 years (P>0.72 for percentage cell loss at all time points).

Conclusions: Descemet's stripping automated endothelial keratoplasty grafts with a diameter of 8.5 mm do not offer a clinical advantage over smaller 8.0-mm grafts for postoperative endothelial cell counts in the first 2 years after surgery.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Publication types

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

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cell Count
  • Corneal Endothelial Cell Loss / diagnosis*
  • Descemet Stripping Endothelial Keratoplasty*
  • Endothelium, Corneal / pathology*
  • Female
  • Follow-Up Studies
  • Fuchs' Endothelial Dystrophy / surgery*
  • Graft Rejection
  • Graft Survival
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tissue Donors