The authors of this study investigated donor and recipient factors associated with operative complications in patients undergoing Descemet stripping automated endothelial keratoplasty (DSAEK).

Study design

Using data from the Cornea Preservation Time Study (CPTS), researchers studied transplantation characteristics of 1,333 eyes undergoing DSAEK.

Outcomes

Tissue-related operative complications occurred in 4.4% of surgeries. On multivariate analysis, the thickness of the cornea prior to lamellar dissection was the only statistically significant predictor of operative complications (P=0.002), even after controlling for epithelial status (off/on), preservation time, and microkeratome head thickness.

For every 50-micron increase in tissue thickness, the odds of operative complications increased by 40%. The authors estimate that donor corneas thinner than 600 microns had a 2% to 5% chance of operative complications, whereas corneas thicker than 600 microns had 9% to 15% chance of complications.

Limitations

Complications were surgeon-reported and differences in surgeon vs eye bank prepared tissue were not analyzed due to confounding factors related to epithelium removal at the time of dissection. The measurement instrumentation for thickness was not standardized to avoid disruption of normal operating processes for each of the 23 eye banks involved in the study. The number of complications was low (n=58), reducing the statistical power to detect other factors that may be associated with operative complications.

Clinical significance

Thicker donor cornea tissue, as measured prior to lamellar dissection, is associated with increased operative complications and should be considered during tissue selection for eyes undergoing DSAEK.