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DSAEK: Practical Approach to Choose the Microkeratome Head on the Basis of Donor Cornea Pachymetry

Wisse, Robert P. L. MD; Achterberg, Jens A. BSc; Van der Lelij, Allegonda MD, PhD

doi: 10.1097/ICO.0000000000000042
Clinical Science

Purpose: The aim of this study was to supply data on the relationship between Descemet stripping automated endothelial keratoplasty (DSAEK) graft thickness and its effects on visual acuity (VA), pace of visual recovery, endothelial cell densities (ECDs), and surgical complications. We additionally provide an approach for choosing the microkeratome blade thickness when multiple patients are scheduled for DSAEK.

Methods: This is a retrospective analysis of all DSAEK procedures performed at our institute from January 2011 to December 2012. The VA was assessed at all postop visits. The ECD was assessed at 6 and 12 months postoperatively. An algorithm based on donor cornea pachymetry was used to assist in the choice of a microkeratome blade either 350 or 400 μm thick. Two groups were created on the basis of the microkeratome blade chosen. Outcomes were given per treatment group.

Results: One hundred two consecutive DSAEK procedures were performed; 60 grafts were prepared with the 350-μm blade and 39 with the 400-μm blade. Baseline characteristics did not differ materially. Grafts dissected using the 350-μm knife were significantly thicker than the grafts dissected with the 400-μm blade, with values of 257 ± 47 μm and 222 ± 33 μm, respectively (P = 0.01). The pace of visual recovery, VA at maximum follow-up, and ECD did not differ significantly between groups. Surgical complications were evenly distributed over both groups.

Conclusions: This study indicates that using neither the 350-μm nor 400-μm microkeratome blade for the DSAEK altered the outcomes in terms of VA, ECD, and surgical complications. The algorithm presented in this study is helpful in equally distributing benefits from thinner grafting for all DSAEK-operated patients.

Supplemental Digital Content is Available in the Text.

Utrecht Cornea Research Group (UCRG), Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.

Reprints: Robert P. L. Wisse, Utrecht Cornea Research Group (UCRG), Department of Ophthalmology, University Medical Center Utrecht, Utrecht 3508 GA, the Netherlands (e-mail:

R. P. L. Wisse and J. A. Achterberg contributed equally to this study.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Received July 02, 2013

Accepted October 25, 2013

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