Table of Contents
Tissue Processing Factors Influencing Descemet Stripping Automated Endothelial Keratoplasty Thickness and Endothelial Outcomes
Nita G. Valikodath, MS, Meraf A. Wolle, MD, MPH, Daniel Sand MD, Lauren Johnson, MS, Maria A. Woodward MD, MS
Introduction: Descemet stripping automated endothelial
keratoplasty tissue thickness can be modified by various tissue
processing factors including microkeratome (MK) head size,
anterior chamber pressure (ACP), and cut pass duration.
Objective: Our primary objective was to evaluate how changes
in MK head size, ACP, and cut pass duration affect endothelial
cell counts and tissue thickness.
Methods: Donor corneas underwent tissue processing under various
combinations of MK head size, ACP, and cut pass duration.
Endothelial cell density (ECD) and optical coherence tomography
(OCT) were recorded both pre- and post-processing. We performed
multivariable linear regression to determine if MK head
size, ACP, and cut pass duration were associated with change in
ECD or tissue cut depth as measured by OCT.
Results: 38 corneas underwent processing. For every 50 μm
increase in MK head size, 77.32 ± 6.71 μm more anterior tissue
was cut (p < 0.0001). For every 5 mmHg increase in ACP,
15.19 ± 6.59 μm more anterior tissue was cut (p=0.03). Cut pass
duration was not associated with tissue cut depth (p=0.19). MK
head size, ACP, and cut pass duration were not associated with
changes in ECD (all p > 0.05).
Conclusions: Tissue processing parameters did not impact ECD.
MK head size and ACP did affect tissue cut depth and is likely
Key Words: endothelial keratoplasty, eye bank, tissue preparation
Abbreviations: DSAEK, Descemet Stripping Automated Endothelial
Keratoplasty; MK, microkeratome; ACP, anterior chamber
pressure; ECD, endothelial cell density; OCT, optical coherence
tomography; TT, tissue thickness; DMEK, Descemet’s membrane
endothelial keratoplasty; BSS, balanced salt solution