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Kuzman T, Meter A, Kalauz M, Masnec S, Škegro I, Jonjić I. Influence of Donor Thickness on Visual Acuity in Descemet’s Stripping Automated Endothelial Keratoplasty . JOVR [Internet]. 2022Nov.24 [cited 2024Jul.26];17(4):462–469. Available from: https://knepublishing.com/index.php/JOVR/article/view/12296
https://doi.org/10.18502/jovr.v17i4.12296
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authors
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Tomislav Kuzman
Tomislav Kuzman
Department of Ophthalmology, University Hospital Center Zagreb, Zagreb, Croatia
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Ana Meter
Ana Meter
Department of Ophthalmology, University Hospital Center Zagreb, Zagreb, Croatia
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Miro Kalauz
Miro Kalauz
Department of Ophthalmology, University Hospital Center Zagreb, Zagreb, Croatia
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Sanja Masnec
Sanja Masnec
Department of Ophthalmology, University Hospital Center Zagreb, Zagreb, Croatia
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Ivan Škegro
Ivan Škegro
Department of Ophthalmology, University Hospital Center Zagreb, Zagreb, Croatia
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Ivana Jonjić
Ivana Jonjić
Department of Ophthalmology, University Hospital Center Zagreb, Zagreb, Croatia
Published Date
- Nov 24, 2022
Influence of Donor Thickness on Visual Acuity in Descemet’s Stripping Automated Endothelial Keratoplasty
Abstract
Purpose: Conventional Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) is a corneal transplantation procedure where the patient’s inner dysfunctional layer is replaced with donor lamella. The data currently present in the literature about the correlation between lamellar thickness and visual acuity is sometimes contradictory and lacks clarity.
Methods: Study included 55 eyes that underwent the conventional DSAEK procedure. Patients had no other comorbidities that could affect visual acuity. Data about lamellar thickness and visual acuity were measured six months after surgery with anterior segment optical coherent tomography (A5-OCT).
Results: The results show that visual acuity before surgery improved from 0.82 to 0.25 logMAR after surgery. Better visual acuity of 0.20 logMAR was achieved with postoperative lamellas thinner than 124 μm, while statistically significantly lower visual acuity of 0.29 logMAR was gained with postoperative lamellas thicker than 124 μm.
Conclusion: Our results suggest that the goal after conventional DSAEK is to have postoperative lamellas thinner than 124 μm in the eye, as this will result in better postoperative visual acuity. This value represents the optimal thickness for conventional DSAEK surgery that could minimize tissue loss for eye banks and surgeons may experience fewer problems during surgery, while obtaining good final visual acuity.
Keywords:
Cornea, Corneal Transplantation, Descemet Stripping Endothelial Keratoplasty, Fuchs’s Endothelial Dystrophy
References
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2. Hyndiuk RA, Schultz RO. Overview of the corneal toxicity of surgical solutions and drugs: and clinical concepts in corneal edema. Lens Eye Toxic Res 1992;9:331–350.
3. McDermott ML, Edelhauser HF, Hack HM, Langston RH. Ophthalmic irrigants: A current review and update. Ophthalmic Surg 1988;19:724–733.
4. Schultz RO, Glasser DB, Matsuda M, Yee RW, Edelhauser HF. Response of the corneal endothelium to cataract surgery. Arch Ophthalmol 1986;104:1164–1169.
5. Hood CT, Woodward MA, Bullard ML, Shtein RM. Influence of preoperative donor tissue characteristics on graft dislocation rate after Descemet stripping automated endothelial keratoplasty. Cornea 2013;32:1527–1530.
6. Pogorelov P, Cursiefen C, Bachmann BO, Kruse FE. Changes in donor corneal lenticule thickness after Descemet’s stripping automated endothelial keratoplasty (DSAEK) with organ-cultured corneas. Br J Ophthalmol 2009;93:825–829.
7. Melles GR. Posterior lamellar keratoplasty: DLEK to DSEK to DMEK. Cornea 2006;25:879–881.
8. Dickman MM, Cheng YY, Berendschot TT, van den Biggelaar FJ, Nuijts RM. Effects of graft thickness and asymmetry on visual gain and aberrations after Descemet stripping automated endothelial keratoplasty. JAMA Ophthalmol 2013;131:737–744.
9. Cheung AY, Hou JH, Bedard P, Grimes V, Buckman N, Eslani M, et al. Technique for preparing ultrathin and nanothin Descemet stripping automated endothelial keratoplasty tissue. Cornea 2018;37:661–666.
10. Maier AK, Gundlach E, Klamann MK, Gonnermann J, Bertelmann E, Joussen AM, et al. Einfluss der Spenderlamellendicke auf die Sehschärfe nach “Descemet’s stripping automated endothelial keratoplasty” (DSAEK). Ophthalmologe 2014;111:128–134.
11. Sharma N, Maharana PK, Singhi S, Aron N, Patil M. Descemet stripping automated endothelial keratoplasty. Indian J Ophthalmol 2017;65:198–209.
12. Neff KD, Biber JM, Holland EJ. Comparison of central corneal graft thickness to visual acuity outcomes in endothelial keratoplasty. Cornea 2011;30:388–391.
13. Busin M, Madi S, Santorum P, Scorcia V, Beltz J. Ultrathin descemet’s stripping automated endothelial keratoplasty with the microkeratome double-pass technique: Two-year outcomes. Ophthalmology 2013;120:1186–1194.
14. Roberts HW, Mukherjee A, Aichner H, Rajan MS. Visual outcomes and graft thickness in microthin DSAEK—oneyear results. Cornea 2015;34:1345–1350.
15. Terry MA, Straiko MD, Goshe JM, Li JY, Davis-Boozer D. Descemet’s stripping automated endothelial keratoplasty: The tenuous relationship between donor thickness and postoperative vision. Ophthalmology 2012;119:1988– 1996.
16. Woodward MA, Raoof-Daneshvar D, Mian S, Shtein RM. Relationship of visual acuity and lamellar thickness in descemet stripping automated endothelial keratoplasty. Cornea 2013;32:e69–e73.
17. Phillips PM, Phillips LJ, Maloney CM. Preoperative graft thickness measurements do not influence final BSCVA or speed of vision recovery after descemet stripping automated endothelial keratoplasty. Cornea 2013;32:1423–1427.
18. Ivarsen A, Hjortdal J. Recipient corneal thickness and visual outcome after Descemet’s stripping automated endothelial keratoplasty. Br J Ophthalmol 2014;98:30–34.
19. Van Cleynenbreugel H, Remeijer L, Hillenaar T. Descemet stripping automated endothelial keratoplasty: Effect of intraoperative lenticule thickness on visual outcome and endothelial cell density. Cornea 2011;30:1195–1200.
20. Tourabaly M, Chetrit Y, Provost J, Georgeon C, Kallel S, Temstet C, et al. Influence of graft thickness and regularity on vision recovery after endothelial keratoplasty. Br J Ophthalmol 2020;104:1317–1323.
21. Pels E, Schuchard Y. Organ-culture preservation of human corneas. Doc Ophthalmol 1983;56:147–153.
22. Park CY, Lee JK, Gore PK, Lim CY, Chuck RS. Keratoplasty in the United States: A 10-year review from 2005 through 2014. Ophthalmology 2015;122:2432–2442.
23. Dickman MM, Peeters JM, van den Biggelaar FJ, Ambergen TA, van Dongen MC, Kruit PJ, et al. Changing practice patterns and long-term outcomes of endothelial versus penetrating keratoplasty: A prospective dutch registry study. Am J Ophthalmol 2016;170:133–142.
24. Kim SE, Lim SA, Byun YS, Joo CK. Comparison of longterm clinical outcomes between Descemet’s stripping automated endothelial keratoplasty and penetrating keratoplasty in patients with bullous keratopathy. Korean J Ophthalmol 2016;30:443–450.
25. Woo JH, Ang M, Htoon HM, Tan D. Descemet membrane endothelial keratoplasty versus Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty. Am J Ophthalmol 2019;207:288–303.
26. Heinzelmann S, Böhringer D, Eberwein P, Reinhard T, Maier P. Outcomes of Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty from a single centre study. Graefes Arch Clin Exp Ophthalmol 2016;254:515–522.
27. Pereira NC, Gomes JÁ, Moriyama AS, Chaves LF, Forseto AD. Descemet membrane endothelial keratoplasty outcomes during the initial learning curve of cornea fellows. Cornea 2019;38:806–811.
28. Singh SK, Sitaula S. Visual outcome of Descemet membrane endothelial keratoplasty during the learning curve in initial fifty cases. J Ophthalmol 2019;2019:5921846.
29. Singh A, Zarei-Ghanavati M, Avadhanam V, Liu C. Systematic review and meta-analysis of clinical outcomes of descemet membrane endothelial keratoplasty versus Descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty. Cornea 2017;36:1437–1443.
30. Dekaris I, Pauk M, Draca N. Pasalic. Descemet stripping automated endothelial keratoplasty – Is a thinner donor lamella the better choice? J Transpl Technol Res 2012;2:1– 5.
31. Romano V, Steger B, Myneni J, Batterbury M, Willoughby CE, Kaye SB. Preparation of ultrathin grafts for Descemet-stripping endothelial keratoplasty with a single microkeratome pass. J Cataract Refract Surg 2017;43:12–15.
32. Shinton AJ, Tsatsos M, Konstantopoulos A, Goverdhan S, Elsahn AF, Anderson DF, et al. Impact of graft thickness on visual acuity after Descemet’s stripping endothelial keratoplasty. Br J Ophthalmol 2012;96:246–249.
33. Khakshour H, Nikandish M, Salehi M, Ghooshkhanehei H, Vejdani A. Evaluation of interface reflectivity and corneal aberrations following Descemet’s stripping automated endothelial keratoplasty. Oman J Ophthalmol 2019;12:108–113.
34. Graffi S, Leon P, Mimouni M, Nahum Y, Spena R, Mattioli L, et al. Anterior segment optical coherence tomography of post-Descemet stripping automated endothelial keratoplasty eyes to evaluate graft morphology and its association with visual outcome. Cornea 2018;37:1087–1092.
2. Hyndiuk RA, Schultz RO. Overview of the corneal toxicity of surgical solutions and drugs: and clinical concepts in corneal edema. Lens Eye Toxic Res 1992;9:331–350.
3. McDermott ML, Edelhauser HF, Hack HM, Langston RH. Ophthalmic irrigants: A current review and update. Ophthalmic Surg 1988;19:724–733.
4. Schultz RO, Glasser DB, Matsuda M, Yee RW, Edelhauser HF. Response of the corneal endothelium to cataract surgery. Arch Ophthalmol 1986;104:1164–1169.
5. Hood CT, Woodward MA, Bullard ML, Shtein RM. Influence of preoperative donor tissue characteristics on graft dislocation rate after Descemet stripping automated endothelial keratoplasty. Cornea 2013;32:1527–1530.
6. Pogorelov P, Cursiefen C, Bachmann BO, Kruse FE. Changes in donor corneal lenticule thickness after Descemet’s stripping automated endothelial keratoplasty (DSAEK) with organ-cultured corneas. Br J Ophthalmol 2009;93:825–829.
7. Melles GR. Posterior lamellar keratoplasty: DLEK to DSEK to DMEK. Cornea 2006;25:879–881.
8. Dickman MM, Cheng YY, Berendschot TT, van den Biggelaar FJ, Nuijts RM. Effects of graft thickness and asymmetry on visual gain and aberrations after Descemet stripping automated endothelial keratoplasty. JAMA Ophthalmol 2013;131:737–744.
9. Cheung AY, Hou JH, Bedard P, Grimes V, Buckman N, Eslani M, et al. Technique for preparing ultrathin and nanothin Descemet stripping automated endothelial keratoplasty tissue. Cornea 2018;37:661–666.
10. Maier AK, Gundlach E, Klamann MK, Gonnermann J, Bertelmann E, Joussen AM, et al. Einfluss der Spenderlamellendicke auf die Sehschärfe nach “Descemet’s stripping automated endothelial keratoplasty” (DSAEK). Ophthalmologe 2014;111:128–134.
11. Sharma N, Maharana PK, Singhi S, Aron N, Patil M. Descemet stripping automated endothelial keratoplasty. Indian J Ophthalmol 2017;65:198–209.
12. Neff KD, Biber JM, Holland EJ. Comparison of central corneal graft thickness to visual acuity outcomes in endothelial keratoplasty. Cornea 2011;30:388–391.
13. Busin M, Madi S, Santorum P, Scorcia V, Beltz J. Ultrathin descemet’s stripping automated endothelial keratoplasty with the microkeratome double-pass technique: Two-year outcomes. Ophthalmology 2013;120:1186–1194.
14. Roberts HW, Mukherjee A, Aichner H, Rajan MS. Visual outcomes and graft thickness in microthin DSAEK—oneyear results. Cornea 2015;34:1345–1350.
15. Terry MA, Straiko MD, Goshe JM, Li JY, Davis-Boozer D. Descemet’s stripping automated endothelial keratoplasty: The tenuous relationship between donor thickness and postoperative vision. Ophthalmology 2012;119:1988– 1996.
16. Woodward MA, Raoof-Daneshvar D, Mian S, Shtein RM. Relationship of visual acuity and lamellar thickness in descemet stripping automated endothelial keratoplasty. Cornea 2013;32:e69–e73.
17. Phillips PM, Phillips LJ, Maloney CM. Preoperative graft thickness measurements do not influence final BSCVA or speed of vision recovery after descemet stripping automated endothelial keratoplasty. Cornea 2013;32:1423–1427.
18. Ivarsen A, Hjortdal J. Recipient corneal thickness and visual outcome after Descemet’s stripping automated endothelial keratoplasty. Br J Ophthalmol 2014;98:30–34.
19. Van Cleynenbreugel H, Remeijer L, Hillenaar T. Descemet stripping automated endothelial keratoplasty: Effect of intraoperative lenticule thickness on visual outcome and endothelial cell density. Cornea 2011;30:1195–1200.
20. Tourabaly M, Chetrit Y, Provost J, Georgeon C, Kallel S, Temstet C, et al. Influence of graft thickness and regularity on vision recovery after endothelial keratoplasty. Br J Ophthalmol 2020;104:1317–1323.
21. Pels E, Schuchard Y. Organ-culture preservation of human corneas. Doc Ophthalmol 1983;56:147–153.
22. Park CY, Lee JK, Gore PK, Lim CY, Chuck RS. Keratoplasty in the United States: A 10-year review from 2005 through 2014. Ophthalmology 2015;122:2432–2442.
23. Dickman MM, Peeters JM, van den Biggelaar FJ, Ambergen TA, van Dongen MC, Kruit PJ, et al. Changing practice patterns and long-term outcomes of endothelial versus penetrating keratoplasty: A prospective dutch registry study. Am J Ophthalmol 2016;170:133–142.
24. Kim SE, Lim SA, Byun YS, Joo CK. Comparison of longterm clinical outcomes between Descemet’s stripping automated endothelial keratoplasty and penetrating keratoplasty in patients with bullous keratopathy. Korean J Ophthalmol 2016;30:443–450.
25. Woo JH, Ang M, Htoon HM, Tan D. Descemet membrane endothelial keratoplasty versus Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty. Am J Ophthalmol 2019;207:288–303.
26. Heinzelmann S, Böhringer D, Eberwein P, Reinhard T, Maier P. Outcomes of Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty from a single centre study. Graefes Arch Clin Exp Ophthalmol 2016;254:515–522.
27. Pereira NC, Gomes JÁ, Moriyama AS, Chaves LF, Forseto AD. Descemet membrane endothelial keratoplasty outcomes during the initial learning curve of cornea fellows. Cornea 2019;38:806–811.
28. Singh SK, Sitaula S. Visual outcome of Descemet membrane endothelial keratoplasty during the learning curve in initial fifty cases. J Ophthalmol 2019;2019:5921846.
29. Singh A, Zarei-Ghanavati M, Avadhanam V, Liu C. Systematic review and meta-analysis of clinical outcomes of descemet membrane endothelial keratoplasty versus Descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty. Cornea 2017;36:1437–1443.
30. Dekaris I, Pauk M, Draca N. Pasalic. Descemet stripping automated endothelial keratoplasty – Is a thinner donor lamella the better choice? J Transpl Technol Res 2012;2:1– 5.
31. Romano V, Steger B, Myneni J, Batterbury M, Willoughby CE, Kaye SB. Preparation of ultrathin grafts for Descemet-stripping endothelial keratoplasty with a single microkeratome pass. J Cataract Refract Surg 2017;43:12–15.
32. Shinton AJ, Tsatsos M, Konstantopoulos A, Goverdhan S, Elsahn AF, Anderson DF, et al. Impact of graft thickness on visual acuity after Descemet’s stripping endothelial keratoplasty. Br J Ophthalmol 2012;96:246–249.
33. Khakshour H, Nikandish M, Salehi M, Ghooshkhanehei H, Vejdani A. Evaluation of interface reflectivity and corneal aberrations following Descemet’s stripping automated endothelial keratoplasty. Oman J Ophthalmol 2019;12:108–113.
34. Graffi S, Leon P, Mimouni M, Nahum Y, Spena R, Mattioli L, et al. Anterior segment optical coherence tomography of post-Descemet stripping automated endothelial keratoplasty eyes to evaluate graft morphology and its association with visual outcome. Cornea 2018;37:1087–1092.