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Lori Lombardi MD, Mark A. Terry MD, Neda Shamie MD, Anand K. Shah MD, Daniel J. Friend MS

Surgeon-cut versus Pre-cut Donor Tissue in Descemet’s Stripping and Automated Endothelial Keratoplasty (DSAEK). Lori Lombardi MD, Mark A. Terry MD, Neda Shamie MD, Anand K. Shah MD, Daniel J. Friend MS. *Dr. Terry has a financial interest in Bausch & Lomb instruments he developed for DSAEK

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Lori Lombardi MD, Mark A. Terry MD, Neda Shamie MD, Anand K. Shah MD, Daniel J. Friend MS

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  1. Surgeon-cut versus Pre-cut Donor Tissue in Descemet’s Stripping and Automated Endothelial Keratoplasty (DSAEK) Lori Lombardi MD, Mark A. Terry MD, Neda Shamie MD, Anand K. Shah MD, Daniel J. Friend MS *Dr. Terry has a financial interest in Bausch & Lomb instruments he developed for DSAEK Other authors have no financial interest

  2. Introduction • DSAEK surgery has revolutionized treatment for various forms of corneal endothelial dysfunction • Successful replacement of damaged endothelium with graft tissue relies on surgical technique as well as favorable tissue characteristics • Previously, surgeons prepared the donor posterior lenticule at the time of surgery • Now, “precut” donor tissue may be prepared by the tissue bank using a Moriamicrokeratome and artificial anterior chamber system

  3. Purpose • This large scale, prospective study compares outcomes of DSAEK surgery using surgeon-cut versus pre-cut donor tissue

  4. Methods • Patients were enrolled in an Institutional Review Board approved protocol for endothelial keratoplasty • Surgical data was gathered in a prospective fashion • Consecutive DSAEK surgeries were compared using Surgeon-cut tissue (n=114) versus Pre-cut tissue (n=207). • Outcome measures reviewed include: • Best spectacle corrected visual acuity (BSCVA) • Endothelial cell loss • Rate of primary graft failure • Graft dislocation rate

  5. Results • Average BSCVA at 6 months: • 20/37 for the Surgeon-cut group (n=114) • 20/38 for the Pre-cut group (n=207) • p = 0.745 • Average BSCVA at 1 year: • 20/33 for the Surgeon-cut (n=108) • 20/42 for the Pre-cut (n=112) • p = 0.044 • With comorbidities removed, BSCVA at 1 year: • 20/33 for the Surgeon-cut (n=106) • 20/41 for Pre-cut (n=108) • p = 0.72

  6. Best Spectacle-Corrected Visual Acuity

  7. Endothelial Cell Loss • Endothelial cell loss at 6 months: • Surgeon-cut = 35% • Pre-cut = 29% • p=0.002 • Endothelial cell loss at 1 year: • Surgeon-cut = 36% • Pre-cut = 29% • p = 0.009

  8. Endothelial Cell Loss

  9. Complications • Primary graft failures: • No primary graft failures occurred in either group • Dislocations: • Two dislocations occurred in the Surgeon-cut group • Ten dislocations in the Pre-cut group • p=0.421

  10. Conclusion • In this large-scale, prospective study, DSAEK using either Surgeon-cut or Pre-cut tissue resulted in comparable patient outcomes and surgical results • BSCVA was not statistically different between groups • Endothelial loss was higher in Surgeon-cut tissue • Dislocations occurred more often in the Pre-cut group • Study includes graft preparation and surgery performed by less experienced surgeons, which may factor into the overall outcomes

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