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Increasing the Storage Time from Pre-Cutting of Donors to the Date of Transplantation Does Not Affect Dislocation Rates, Graft Failure Rates, or Endothelial Cell Loss
Zachary M. Mayko, MS, Mark A. Terry, MD, Paul Phillips, MD, Christopher G. Stoeger, MBA, CEBT, Michael D. Straiko, MD
DSAEK, pre-cut, eye bank
Purpose: To determine if the time from pre-cutting tissue with a microkeratome in the Eye Bank to transplantation affects post-operative complications or donor endothelial cell density (ECD) loss.
Methods: We identified 797 Descemet stripping automated endothelial keratoplasty (DSAEK) surgeries performed at two sites between 2008 and 2014. The time from microkeratome cutting to transplantation, and complications were recorded. Six month correlation analysis was performed on 620 grafts that had ECD counts preoperatively and at 6 months. Preparation to transplant intervals of < 1 day (n=53), 1 day (n=444), 2 days (n=113) and > 2days (n=10) were compared for dislocation rates, iatrogenic graft failure rates, late graft failure rates, and post-op % ECD loss.
Results: There was a weak but statistically significant relationship between ECD loss and time between pre-cutting and transplantation (p=.02). The mean % ECD loss was 24%, 20%, 18% and 29% for tissues stored <1 day, 1 day, 2 days and >2 days. There were 0 dislocations in the <1 day group (0%), 12 in the 1 day group (3%), 5 in the 2 day group (3%) and 1 in the greater than 2 day group(10%) respectively. There were 3 iatrogenic graft failures, and no late graft failures.
Conclusion: Dislocation rates, graft failure rates, and ECD loss at 6 months after DSAEK is similar whether the tissue is cut immediately before use or stored for 2 days. Surgeons can feel comfortable accepting tissue which is cut at least 2 days before use.