Ultra-thin DSAEK might become the standard in endothelial keratoplasty

BASSANO, Italy — Ultra-thin Descemet's stripping automated endothelial keratoplasty is probably the future of endothelial keratoplasty, maintaining the advantages of both standard DSAEK and Descemet's membrane endothelial keratoplasty, according to a specialist.

"DMEK, where only the Descemet's lamella is implanted, gives superior visual results but poses several surgical challenges, from preparation to positioning and attachment of the lamella. With ultra-thin DSAEK, we have comparable results but the surgical advantages of a stromal support," Simonetta Morselli, MD, speaking on behalf of Massimo Busin, MD, said at a meeting on mini-invasive surgery here.

To prepare ultra-thin DSAEK grafts, the stroma is hydrated with a hypo-osmotic solution that is manually injected using a 30-gauge needle. Stromal dissection is then performed in two steps, using a microkeratome.

"The first debulking cut is performed using a 300- to 350-µm head. Then, a second refinement cut is done with a 200- to 250-µm head. The depth of the cuts is selected according to the pachymetry of the residual stroma," Dr. Morselli said.

Implantation in the recipient eye is then performed with the same methods of standard DSAEK, using a Busin glide and an air bubble.

Eye banks are now studying a similar preparation, and ultra-thin DSAEK pre-cut tissue will soon be available from eye banks.

"Compared to the standard DSAEK lamellar graft, which is 100 µm to 150 µm thick, we can reduce the thickness to 70 µm, 60 µm or even 50 µm," Dr. Morselli said.

In all the cases treated with this method by Dr. Busin, refractive results, transparency and endothelial cell counts have been good.

"Ultra-thin DSAEK is easier and more reproducible than DMEK and leads to comparable visual outcomes. Endothelial cell loss is comparable to standard DSAEK and less than DMEK," Dr. Morselli said.

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