Primary graft failure in preloaded vs surgeon prepared DSAEK: a clinical and ex vivo correlation study.

PURPOSE: To evaluate whether primary graft failure (PGF) rates and endothelial cell loss (ECL) differ between surgeon-trephined/loaded and eye bank-preloaded Descemet-stripping automated endothelial keratoplasty (DSAEK) grafts.

SETTING

Tertiary care academic center.

DESIGN

Retrospective case series and ex vivo laboratory study.

METHODS

Single-center review of 69 eyes undergoing DSAEK (2020-2023) divided into 3 groups based on graft preparation and eye bank source: (1) eye bank-preloaded in EndoSerter (PL-ES), (2) eye bank-preloaded in glass tube (PL-GT), and (3) surgeon-trephined/loaded in EndoSerter (SL-ES). The primary clinical outcome was PGF (persistent corneal edema >3 months despite medical therapy). Secondary outcomes included visual outcomes and clinical complications (cystoid macular edema [CME] and rebubbling rate [RR]). The primary outcome of the laboratory study was percentage ECL (%ECL).

RESULTS

All lenticules were ≤80 μm. PGF was significantly higher in the PL-ES group (8/20; 40%) and the PL-GT group (4/7; 57%) compared with the SL-ES group (1/42; 2%) ( P < .0001). Grafts requiring rebubbling were more likely to experience PGF ( P = .0176). PGF eyes were regrafted with SL-ES DSAEK; none experienced subsequent PGF. There were no significant differences in CME, RR, corrected distance visual acuity, and spherical equivalent. The ex vivo study included 9 PL-ES, 6 PL-GT, and 6 SL-ES grafts. %ECL was higher in both preloaded groups than SL-ES ( P = .0354), although significance was not demonstrated on post hoc analysis. Fluorescent imaging revealed more cell loss in preloaded grafts.

CONCLUSIONS

Preloading and storage of DSAEK grafts may affect PGF rates clinically and ECL ex vivo.