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  • Does Cornea Preservation Time Affect DSAEK Success?

    By Lynda Seminara
    Selected By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, December 2017

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    Although donor corneas can be preserved in FDA-approved solutions for up to 14 days, many surgeons will not use cornea tissue that has been preserved for more than 7 days. To examine the effect of preservation time on graft success, Rosenwasser et al. compared 3-year outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) among corneas preserved for varying periods. They found that preservation time of < 12 days was linked to better success rates.

    This double-masked randomized trial was conducted at 40 U.S. clinical sites (70 surgeons) from April 2012 to June 2017.

    Eligible patients scheduled to undergo DSAEK for Fuchs endothelial corneal dystrophy (94.4% of participants) or pseudophakic or aphakic corneal edema received donor corneas preserved for ≤ 7 days (675 eyes) or 8-14 days (655 eyes). The median participant age was 70 years (range, 42-90 years), and 60.2% were female. Demographics of the study groups were similar.

    The 3-year cumulative probability of graft success was 95.3% for donor corneas preserved for ≤ 7 days and 92.1% for those preserved 8-14 days. The upper limit of the 1-sided 95% confidence interval of this difference was 5.4%, which surpassed the noninferiority limit of 4% and was attributed to more primary donor failures in the group with longer preservation time (conditional probability of failure after the first month: 3.1% vs. 2.4%).

    A secondary analysis showed that the likelihood of graft success decreased as preservation time increased. The success rate was lower for a period of 12-14 days (89.3%) than for ≤ 4 days (96.5%), 5-7 days (94.9%), or 8-11 days (93.8%).

    The comparable success rates attained for corneas that had been preserved for up to 11 days should reassure surgeons. The high 3-year success rates with DSAEK for Fuchs dystrophy, regardless of preservation time, suggest that corneas that have been preserved for a longer time period can be used when necessary.

    The original article can be found here.