Precut tissue in Descemet's stripping automated endothelial keratoplasty

Purpose: To describe donor characteristics of eye bank-prepared precut tissue used in Descemet's stripping automated endothelial keratoplasty (DSAEK) and report any increase in immediate postoperative complications associated with its use. Design: Prospective, noncomparative, interventional case series. Participants: One hundred donor corneas deemed appropriate for transplant and 100 eyes undergoing DSAEK for endothelial dysfunction. Methods: Precut donor tissue was evaluated in a prospective study of 100 consecutive cases of DSAEK surgery. Donor characteristics and the immediate postoperative complications of donor tissue dislocation and graft failure with the use of precut tissue were recorded and analyzed. Main Outcome Measures: Preoperative donor characteristics (age, time from death to preservation, time from death to implantation, time from cut to implantation, residual stromal bed thickness, pre- and postcut endothelial density), rate of dislocation, and rate of primary graft failure. Results: Average donor age was 57.6 +/- 10.8 years, average time from death to preservation was 9.8 +/- 3.2 hours, average time from death to implantation was 94.5 +/- 33.5 hours, and average time from cut to implantation was 26.0 +/- 17.4 hours. The average residual stromal bed thickness was 169 +/- 36 microns. The average endothelial cell density (ECD) after cutting was 2709 +/- 292 cells/mm(2) (n = 100). In the subgroup of donors in whom pre-resection and postresection endothelial cell densities were available (n = 80), the average ECD before cutting was 2743 +/- 253 cells/mm(2) and the average ECD after cutting was 2644 +/- 257 cells/mm(2). This average cell loss of 3.7% was statistically significant (P < 0.001). There was only 1 dislocation in this entire series of 100 eyes. There were no primary graft failures. Conclusion: The use of precut tissue in DSAEK had a low rate of early postoperative complications such as graft dislocation (1%) and primary graft failure (0%). A wide range of donor characteristics such as donor age, death to transplantation time, precutting to transplantation time, and donor lenticule thickness resulted in excellent adhesion of the tissue and clear grafts.