Descemet's stripping with endothelial keratoplasty - Comparative outcomes with microkeratome-dissected and manually dissected donor tissue

Purpose: To compare outcomes with 2 donor dissection methods for Descemet's stripping with endothelial keratoplasty (DSEK). Design: Retrospective, comparative, nonrandomized case series. Participants: Three hundred thirty consecutive transplants, 114 with manually dissected and 216 with microkeratome-dissected donor tissue. Methods: Donor posterior stroma/endothelium was transplanted, after stripping recipient Descemet's membrane/endothelium and dissecting the donor tissue by hand or with a microkeratome. Main Outcome Measures: Incidences of donor perforation and donor detachment were compared for all eyes. Visual and refractive outcomes were compared for the first 100 consecutive eyes in each group. Results: Visual recovery was faster with microkeratome-dissected donor tissue, as evidenced by statistically better best spectacle-corrected visual acuity (VA) in that group 1 month after surgery (P=0.015). Best spectacle-corrected VA was statistically comparable for the 2 groups preoperatively and 3 and 6 months postoperatively. Best spectacle-corrected VA was not correlated significantly with postoperative central corneal thickness (P=0.25). Corneal thickness was significantly higher in the microkeratome group (690 +/- 77 mu m, compared with 610 +/- 62 mu m after hand dissection; P > 0.0001). Mean refractive astigmatism was 1.5 diopters (D) preoperatively and 6 months postoperatively in both groups. Spherical equivalent refraction did not change in the microkeratome group (P=0.64) but increased by 0.66 D in the hand dissection group (P=0.0007). Methods designed to remove fluid from the donor/recipient graft interface ultimately reduced the detachment rate to < 1% (1 in the last 140 cases). No donor perforations occurred in 216 microkeratome dissections, compared with 5 in 114 hand dissections (P=0.002). Conclusions: Microkeratome dissection reduced the risk of donor tissue perforation, provided faster visual recovery after DSEK, and did not alter the refractive outcome. (c) 2006 by the American Academy of Ophthalmology.