Cornea Grafts: Ensuring Success

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This month, News in Review highlights selected papers from the original papers sessions at AAO 2018. Each was chosen by the session chair because it presents important news or illustrates a trend in the field. Only 4 subspecialties are included here; papers sessions will also be held in 5 other fields. For more information, see the Meeting Program, which you’ll find in your meeting bag, or the Mobile Meeting Guide.

Graft failure after Descemet stripping automated endothelial kera­toplasty (DSAEK) is more likely if the donor has diabetes or pseudophakic/aphakic corneal edema (PACE) and if there were complications during the surgery, researchers in the Corneal Preservation Time Study (CPTS) have found.¹

Building on previous evidence. Earlier reports from the CPTS showed that graft preservation time of up to 11 days did not impact the 3-year success rate of DSAEK² and that preservation time of up to 13 days did not affect en­dothelial cell loss.3 In further analysis of data from this randomized, prospective clinical trial (1,330 eyes), the research­ers looked for the influence on trans­plant success of secondary donor and recipient factors, said coauthor Mark A. Terry, MD, at the Devers Eye Institute in Portland, Oregon.

Risk of failure. The CPTS research­ers found that early graft failure (within 8 weeks of surgery) was twice as likely if the donor tissue came from someone with diabetes and 4 times as likely if the recipient had a preoperative diagno­sis of PACE. Even so, the 3-year graft success was over 90% when diabetic donor tissue was used and over 83% in recipients with PACE, Dr. Terry said.

Impact of operative factors. The analysis revealed that the surgeon’s insertion technique did not matter but that surgical complications did, Dr. Terry said. “This study looked at many different ways of doing the surgery, and we found that it really doesn’t matter what way you did the surgery, as long as you did the surgery well,” he said. However, he added, “If the surgeon reported a complication during the sur­gery, those eyes had a highly statistically significant difference in success rates in terms of endothelial cell count and in terms of lasting 3 years.”

Evidence-based road map. When these results are combined with the ear­lier CPTS results, cornea surgeons now have an evidence-based road map that can increase their chances of successful DSAEK, Dr. Terry said.

“These are the guidelines we’re of­fering surgeons: We’re telling them that their common preconceived notions of what constitutes the ‘best’ donor tissue is wrong—it turns out that age, storage time, and cell count of the donor tissue don’t matter,” he said.

Dr. Terry added, “Don’t ask for young tissue; it doesn’t make a difference. Don’t ask for high endothelial cell counts; it doesn’t make a difference. Don’t ask for tissue that was harvested a day or 2 ago; it doesn’t make a difference. Even the minimal standards set by the eye bank for quality donor tissue will yield excellent results in DSAEK surgery.”

—Linda Roach

1 Terry MA et al., on behalf of the Cornea Preservation Time Study Group. Ophthalmology. Published online Aug. 8, 2018.

2 Rosenwasser GO et al. JAMA Ophthalmol. 2017;135:1401-1409.

3 Lass JH et al. JAMA Ophthalmol. 2017;135:1394-1400.

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Relevant financial disclosures—Dr. Terry: Bausch + Lomb: P,L; Envisia: C; Moria: L.

For full disclosures and the disclosure key, see below.

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