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DSAEK with precut tissue yields improved visual acuity, stable endothelial cell loss
Ophthalmology. 2009;116(2):248-256.
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Precut corneal tissue for Descemet’s stripping automated endothelial keratoplasty improved visual acuity and resulted in stable endothelial cell loss.
“Importantly, this is the largest series ever reported using pre-cut donor tissue for a single DSAEK technique,” the study authors said.
The prospective study included 100 eyes of 90 patients with endothelial dysfunction and clinically evident stromal edema. Visual acuity data were available on all 100 eyes at preoperative assessment and 6-month follow-up. At 12 months, visual acuity data were available for 79 eyes, refractive astigmatism data for 72 eyes, topography for 65 eyes, pachymetry for 71 eyes and specular microscopy for 61 eyes.
Study data showed best corrected visual acuity improving from 20/83 preoperatively to 20/38 at 6 months and 20/39 at 12 months after surgery. Refractive astigmatism changed an average 0.09 D at 6 months and 0.1 D at 12 months. Changes in astigmatism were not statistically significant.
Mean endothelial cell loss at 12 months was 29%. However, endothelial cell loss was stable between 6 months and 12 months, the authors said.
This adds to the growing body of literature indicating that precut donor tissue for endothelial keratoplasty procedures is safe and comparable to surgeon-cut tissue. Surgeons need to evaluate their volume of EK cases to decide if it makes financial sense to use precut tissue. In our area, Medicare currently pays just over the cost of a microkeratome blade for the “backbench” surgeon fee, but the cost of the tissue is a pass-through. This makes the decision easy to use precut tissue. However, private carriers usually pay a more realistic fee for preparation of the tissue and many times do not make the tissue charges a pass-through separately reimbursed from the facility fee, making it an easy decision for a busy surgeon or center to use surgeon-cut tissue.
While it is stated to be a prospective study, the study has the same potential biases as any retrospective study, with 35% of eyes at 6 months and 39% at 1 year lost to follow-up or missing key data for exams.
– Francis W. Price Jr., MD
OSN Cornea/External Disease Board Member