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A Simple 60-Second Swelling Technique for More Consistent Ultrathin DSAEK Graft Preparation

Farbman, Neil H. MD, JD*; Y. Li, Jennifer MD*; Ling, Jennifer MD*; Conwell, Chris CEBT; Ramirez, Tiffany CEBT

doi: 10.1097/ICO.0000000000002048
Clinical Science

Purpose: The purpose of this study is to describe a simple but novel 60-second swelling technique for ultrathin Descemet stripping automated endothelial keratoplasty (DSAEK) graft preparation. In addition, we aim to demonstrate the effectiveness of this technique in obtaining thinner DSAEK grafts more consistently without compromising graft quality.

Methods: We performed a retrospective case–control study comparing standard DSAEK preparation using an ML7 Microkeratome Donor Cornea System (Med-Logics Inc, Athens, TX) with an additional 60 seconds of stromal swelling with a balanced salt solution after the removal of the epithelium but before the microkeratome pass. Thirty cases using this novel swelling technique were compared with controls matched by age, sex, and precut corneal thickness. Donor characteristics and both precut and postcut graft characteristics were analyzed.

Results: DSAEK grafts prepared with our simple swelling method were approximately 13 μm thinner on average than those prepared with our conventional ultrathin DSAEK preparation technique (P = 0.001). The frequency of grafts less than 100 μm was much greater with swelling (93.3% vs. 63.3% with conventional technique, P = 0.0052). There were no significant differences in postcut cell counts or decrease in cell counts between the groups.

Conclusions: A simple 60-second swelling technique can yield significantly thinner DSAEK tissue in a more consistent range without a significant impact on the endothelial cell count.

*UC Davis Eye Center, Sacramento, CA; and

Sierra Donor Service Eye Bank, West Sacramento, CA.

Correspondence: Jennifer Y. Li, MD, UC Davis Eye Center, 4860 Y St, Suite 2400, Sacramento, CA 95817 (e-mail:

The authors have no conflicts of interest to disclose.

N. H. Farbman received an EBAA travel grant and financial support from UC Davis to support the presentation of these data at the 2017 EBAA Scientific Symposium.

Received March 20, 2019

Received in revised form May 20, 2019

Accepted May 21, 2019

Online date: July 3, 2019

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