Comparing Clinical Outcomes of Descemet's Membrane Stripping Automated Endothelial Keratoplasty Between Graft Insertion Methods

Ji Won Baek; Kyu Yeon Hwang; Choun-Ki Joo

doi:10.3341/jkos.2013.54.11.1655

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Baek, Hwang, and Joo: Comparing Clinical Outcomes of Descemet's Membrane Stripping Automated Endothelial Keratoplasty Between Graft Insertion Methods

Original Article

J Korean Ophthalmol Soc 2013;54(11):1655-1662.

Published online: 2 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.11.1655

Comparing Clinical Outcomes of Descemet's Membrane Stripping Automated Endothelial Keratoplasty Between Graft Insertion Methods

Ji Won Baek, MD, Kyu Yeon Hwang, MD, Choun-Ki Joo, MD

Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea

Address reprint requests to Choun-Ki Joo, MD, PhD, Department of Ophthalmology, Seoul St. Mary's Hospital, #222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea, Tel: 82-2-2258-1188, Fax: 82-2-599-7405, E-mail: ckjoo@catholic.ac.kr

Received 29 March 2013 Revised 3 June 2013 Accepted 23 September 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare clinical outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) between different graft insertion methods

Methods

The clinical records of 32 eyes of 30 DSAEK patients were retrospectively analyzed. Patients were divided into 2 groups according to graft insertion method. Group A: Taco-folding, group B: Tan-endoglide. The best corrected visual acuities (BCVA), intraocular pressures, astigmatism, endothelial cell count, central corneal thickness and complications were evaluated pre and post-operatively.

Results

The average follow-up period was 19 months (range 1-67). Postoperative log MAR visual acuity had significantly improved both from 1.63 (log MAR) to 0.69 and 0.53 at 12 months in each group (p = 0.035 p = 0.000). Mean endothelial cell survival of each group at 1 month postoperative were 75.8% (range 62.7-88.6) and 87.7% (range 70.2-97.9), respectively (p = 0.012). The differences of BCVA improvement and endothelial cell survival between the groups at 12 months were not significant (p = 0.393, p = 0.544).

Conclusions

Both methods showed fast visual recovery. Using Tan-endoglide insertion resulted less endothelial cell loss at early post-operative period and showed less post-operative complication and graft failure.

Keywords: DSAEK, Tan-endoglide, Taco-folding, Keratopkasty

References

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Figure 1.

Post-operative visual acuity and astigmatism changes of of Descemet's stripping automated endothelial keratoplasty (DSAEK) patients by insertion method. *Mann-Whitney U test between Taco-folding group and Tan-endoglide group.

Figure 2.

Central corneal thickness of Descemet's stripping automated endothelial keratoplasty (DSAEK) patients by donor insertion method. *Mann-Whitney U test between Taco-folding group and Tan-endoglide group.

Figure 3.

Mean endothelial cell density and endothelial cell survival of Descemet's stripping automated endothelial keratoplasty (DSAEK) patients by insertion method. ^*Mann-Whitney U test between Taco-folding group and Tan-endoglide group.

Figure 4.

Early post-operative intraocular pressure changes of of Descemet's stripping automated endothelial keratoplasty (DSAEK) patients by insertion method. *Mann-Whitney U test between Taco-folding group and Tan-endoglide group.

Table 1.

Demographic and Operative Details of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) Patients.

		Taco-folding (n = 10)	Tan-endoglide (n = 22)	p-value
Sex	Male	8	13
	Female	2	9
Age (years)	Mean	61.9 ± 6.86	60.24 ± 11.82	0.764
	Range	54-73	35-82
Preoperative corrected visual acuity (scale)	Mean	1.63 ± 0.80	1.63 ± 0.65	0.675
	Range	0.7-3.0	0.4-3.0
Preoperative corneal endothelial density (scale)	Mean	2700 ± 159.8	2820 ± 191.3	0.094
	Range	2475-2873	2532-3155
Donor graft diameter (scale)	Mean	8.00 ± 0.00	8.02 ± 0.08	0.693
	Range	All 8.00	8.00-8.25
Indication for surgery	Pseudophakic bullous keratopathy	5 (50%)	11 (50%)
	Fuchs endothelial dystrophy	1 (10%)	4 (18%)
	Post-laser iridotomy-associated bullous keratopathy	1 (10%)	2 (9%)
	Posterior polymorphous corneal dystrophy	1 (10%)	2 (9%)
	Failed DSAEK	2 (20%)	3 (13%)
Surgery performed	DSAEK	8 (80%)	16 (72%)
	DSAEK + phacoemulsification/IOL	2 (20%)	5 (28%)
Donor graft preperation method	Microkeratome (surgeon-cut)	9	0
	Microkeratome (precut)	1	22

Values are presented as mean ± SD.

IOL = intraocular lens.

Table 2.

Pre and post-operative clinical data of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) Patients

	BCVA (log MAR) mean (range)					IOP (mm Hg) mean (range)					Astigmatism (D) mean (range)
Time	Preop	3 months	6 months	12 months	p-value^*	Preop	3 months	6 months	12 months	p-value^†	Preop	3 months	6 months	12 months	p-value^*
Taco-folding	1.63	0.91	0.78	0.69	0.035	15.2	14.1	13.7	14.6	0.134	4.10	3.35	2.78	2.71	0.028
(n = 10)	(0.7-3.0)	(0.3-1.7)	(0.3-1.4)	(0.3-1.1)		(7-19)	(11-18)	(10-16)	(8-19)		(1.25-6.25)	(1-5.25)	(1.25-4.25)	(1.5-4.25)
		(n = 8)	(n = 7)	(n = 7)			(n = 8)	(n = 7)	(n = 7)		(n = 7)	(n = 8)	(n = 7)	(n = 7)
Tan-endoglide	1.63	0.89	0.69	0.53	0.000	14.3	13.1	13.5	13.3	0.876	3.40	3.03	2.88	2.71	0.030
(n = 22)	(0.4-3.0)	(0.2-2.0)	(0.1-1.7)	(0.1-1.0)		(6-24)	(5-22)	(6-23)	(8-19)		(0.75-6.25)	(0.5-6.5)	(0.75-6.25)	(0.5-6.25)
		(n = 21)	(n = 20)	(n = 13)			(n = 21)	(n = 20)	(n = 13)		(n = 18)	(n = 21)	(n = 20)	(n = 13)
p-value^‡	0.675	0.920	0.160	0.393		0.345	0.704	0.589	0.176		0.423	0.704	0.589	0.176
All eyes	1.63	0.90	0.80	0.72	0.000	14.6	13.4	13.6	13.7	0.453	3.60	3.11	2.84	2.71	0.004
(n = 32)	(0.4-3.0)	(0.2-2.0)	(0.1-2.0)	(0.2-1.7)		(6-24)	(5-23)	(6-23)	(8-19)		(0.75-6.25)	(0.5-6.5)	(0.75-6.25)	(0.5-6.25)
		(n = 29)	(n = 27)	(n = 20)			(n = 29)	(n = 27)	(n = 20)		(n = 25)	(n = 29)	(n = 27)	(n = 20)

BCVA = best corrected visual acuity; IOP = intraocular pressure; D = diopter; Preop = preoperative.

^* Wilcoxon signed rank test between preoperative and postoperative 12 months;

^† Friedman test;

^‡ Mann-Whitney U test between Taco-folding group and Tan-endoglide group.

Table 3.

Postoperative complications and survival rate of Descemet's stripping automated endothelial keratoplasty (DSAEK) patients

Types of complications	Taco-folding (n = 10) (%)	Tan-endoglide (n = 22) (%)
Elevated intraocular pressure (>21 mm Hg)	3 (30)	6 (27)
Graft detachment & repositioning	2 (20)	2 (9)
Transient graft rejection	2 (20)	2 (9)
Graft failure	3 (30)	4 (18)
Successful re-DSAEK after graft failure	1 (10)	1 (4.5)
Graft survival rate at 12 month (%)	70	82

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