This retrospective study found that Descemet stripping automated endothelial keratoplasty (DSAEK) corneal donor graft thickness may not play an important role in the final BSCVA, refractive error or accuracy of IOP measurement. The authors conclude that the ideal DSAEK graft thickness to minimize graft-related complications remains to be determined.
The optimal graft thickness in DSAEK is still a matter of controversy. Thinner grafts are more difficult to manipulate but regarded as better for visual rehabilitation. However, the results of this study did not confirm this perception. The study is important as it gives physicians leeway in accepting a wide range of graft thicknesses as eye banks are not always able to cut the tissue to an exact pre-specified thickness.
The authors reviewed the charts of 460 eyes that had undergone DSAEK. They were segregated into three groups based on preoperative donor graft thickness: < 100 mm (n = 67 eyes), 100 to 150 mm (n = 316 eyes) and >150 mm (n = 77 eyes).
At about six months after surgery, all groups showed significant improvement in BSCVA (mean ± SD = ‑ 0.34 ± 0.50 logMAR), mild hyperopic shift (0.48 ± 1.7 D), and stable IOP (0.19 ± 4.8 mmHg). However, there were no significant differences in groups according to donor graft thicknesses with respect to change in BSCVA (P = 0.8), hyperopic shift (P = 0.76) or IOP measurement (P = 0.56).
A limitation of the study is that the authors did not measure other metrics of visual quality, such as higher order aberrations and contrast sensitivity, which may be affected by graft size and may impact overall patient functioning.
They say this study proves that DSAEK is an effective means of treating endothelial dysfunction and tolerates a wide range of donor graft thicknesses with equivalent results.
They conclude that based on the present study, surgeons should worry less about DSAEK graft thicknesses and more about surgical techniques and endothelial cell health.