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Five-Year Outcomes of Ultrathin Descemet Stripping Automated Endothelial Keratoplasty

Madi, Silvana MD*,†,‡; Leon, Pia MD†,§; Nahum, Yoav MD¶,‖; D'Angelo, Sergio MD**; Giannaccare, Giuseppe MD††; Beltz, Jacqueline MD, FRANZCO†,‡‡; Busin, Massimo MD*,†,§§

doi: 10.1097/ICO.0000000000001999

Purpose: To report 5-year outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) with a central graft thickness intended to be <100 μm.

Methods: This retrospective, consecutive, interventional case series included 354 eyes with endothelial decompensation due to various causes (Fuchs endothelial dystrophy, pseudophakic or aphakic bullous keratopathy, failed previous graft, herpetic endothelitis, or buphthalmos). Donor tissue was prepared using the microkeratome-assisted double-pass technique aiming at a graft thickness <100 μm. The Descemet membrane was stripped under air. The graft was delivered into the anterior chamber using the pull-through technique through a 3.2-mm clear corneal incision using a modified Busin glide. The best spectacle-corrected visual acuity (BSCVA), endothelial cell loss, graft survival rates, and immunologic rejection rates were evaluated.

Results: Follow-up data at 1, 2, 3, and 5 years after UT-DSAEK were collected from 214, 172, 147, and 105 eyes, respectively. After excluding eyes with comorbidities, BSCVA better than or equal to  20/20 was recorded in 36.3%, 37.4%, 46.4%, and 53.4% of eyes, respectively, whereas BSCVA better than or equal to 20/40 was documented in 95.5%, 95.3%, 96.0%, and 96.6% of eyes, respectively. The mean endothelial cell loss was 35.4%, 42.3%, 43.3%, and 52.3%; Kaplan–Meier graft survival probability was 99.1%, 96.2%, 94.2%, and 94.2%, and Kaplan–Meier cumulative probability of a rejection episode was 3.4%, 4.3%, 5%, and 6.9% at 1, 2, 3, and 5 years, respectively.

Conclusions: UT-DSAEK grafts allow excellent 5-year outcomes, including BSCVA, endothelial cell density, and survival rates comparable with those recorded post-Descemet membrane endothelial keratoplasty, but with a higher immunologic rejection rate.

*Department of Ophthalmology, Ospedali Privati Forlì, Forlì, Italy;

Istituto Internazionale per Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy;

Ophthalmology Department, Alexandria University, Alexandria, Egypt;

§Department of Ophthalmology, SS. Giovanni e Paolo” Hospital, Venice, Italy;

Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel;

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;

**Department of Biomedical Sciences and Specialized Surgery, University of Ferrara, Ferrara, Italy;

††Department of Ophthalmology, S. Orsola-Malpighi Hospital, DIMES, University of Bologna, Italy;

‡‡Royal Victorian Eye and Ear Hospital, Melbourne, Australia; and

§§Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.

Correspondence: Massimo Busin, MD, Department of Ophthalmology, Ospedali Privati Forlì, Viale Gramsci 42, 47122 Forlì, Italy (e-mail:

M. Busin receives reimbursement of travel expenses and royalties from Moria (Antony, France); Y. Nahum is a paid consultant for Shire Plc and Taro pharmaceuticals. The remaining authors have no funding or conflicts of interest to disclose.

Presented as a paper at the Annual Meeting of the American Academy of Ophthalmology; November 11–14, 2017; New Orleans, LA.

Received February 05, 2019

Received in revised form March 31, 2019

Accepted April 02, 2019

Online date: May 29, 2019

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