Lower risk of graft dislocation applying organ cultured corneas compared with cold short-term cultured corneas during DSAEK surgery

Abstract

Background: To investigate factors that may affect graft dislocation after uneventful Descemet stripping endothelial keratoplasty (DSAEK), with a special focus on different donor cornea storage conditions. Methods: All DSAEK surgeries performed during 6 years in our hospital were retrospectively investigated. Patients with previous intraocular surgeries other than cataract extraction were excluded. Donor data (age, gender, death-to-preservation time, cornea storage conditions, graft storage time, and estimated thickness of the graft) and patient information (age, gender, and indication for surgery) were noted. Results: A total of 26 dislocations (6.6%) out of 394 DSAEK surgeries were found. The dislocation rate was considerably reduced between 2011 and 2016, due to more experienced surgeons. There was a significantly higher dislocation rate with the use of donor corneas stored in cold storage solution (12.7%) compared with organ culture solution (2.5%) (P < 0.001). During the study period, donor corneas stored in cold storage solution and organ culture solution were applied in 158 (40%) and 236 (60%) cases, respectively. There were no differences in recipient age and gender between patients who received corneas from the two storage systems, indicating a random distribution of grafts. In a multivariate analysis, only operation year (reduced rate over the years) and cold storage solution were statistically significantly associated with graft dislocation. Conclusion: This study suggests that the type of storage solution may have a decisive role in graft dislocation in DSAEK surgery.