Diabetic cornea donor, operative complications tied to graft failure
Success of Descemet stripping automated endothelial keratoplasty (DSAEK) in the early and entire postoperative period is very probable if without operative complications and when the donor does not have diabetes, a recent study has found.
Moreover, DSAEK success in the long-term postoperative period is more likely in recipients with Fuchs dystrophy vs those with pseudophakic or aphakic corneal edema (PACE).
Of the 1,330 grafts, 1,251 (94 percent) remained clear after 3 years and were deemed successful. After adjusting for preservation time (PT), an association was found between tissue from donors with diabetes (risk ratio [RR], 2.35; 99 percent CI, 1.03–5.33) as well as operative complications (RR, 4.21; 1.42–12.47) and increased risk for primary or early failure.
Preoperative diagnosis of PACE (RR, 3.59; 1.05–12.24), compared with Fuchs dystrophy, correlated with increased risk for late failure by 3 years after surgery.
There was little variation in graft success among other factors examined, as follows: donor age (RR, 1.19 per decade; 0.91–1.56 per decade), preoperative donor endothelial cell density (RR, 1.10 per 500 cells; 0.74–1.63 per 500 cells), graft diameter (RR, 1.22 per 1 mm; 0.39–3.76 per 1 mm) and injector use for graft insertion (RR, 0.92; 0.40–2.10).
“Mechanisms whereby diabetic donors and PACE recipients reduce the rate of graft success after DSAEK warrant further study,” the investigators said.
Eyes undergoing DSAEK were randomly assigned to receive a donor cornea with PT of 0–7 days (n=675) or 8–14 days (n=655). Donor, recipient and operative parameters were prospectively recorded.
Graft failure was defined as regraft for any reason, graft that failed to clear by 8 weeks after surgery, or an initially clear graft that became and remained cloudy for 90 days. Failure in the first 8 weeks was further categorized as primary donor failure or early failure, in the absence or presence of operative complications, respectively.
The investigators estimated RRs and 99 percent CIs for graft failure by using proportional hazards and logistic regression models.