Getting to the Crux of DSAEK Cuts

A clear divide currently dictates the use of Descemet stripping automated endothelial keratoplasty (DSAEK) to treat endothelial failure: either when the lamella tissue is cut in the operating theatre (surgeon cut) or when it is pre-cut at a tissue bank beforehand. According to Thorbjörg Olafsdottir MD, the use of the pre-cut technique has been increasing, as it is more efficient and eliminates the risk of graft perforation during surgical preparation. But is there a difference in detachment rates between the two techniques?

Dr Olafsdottir decided to find out by comparing the detachment rate of both the surgeon-cut and pre-cut techniques. The resulting retrospective study was conducted between 2019 and 2023 at Skåne University Hospital, Lund, Sweden.

Patients were split into three groups based on graft preparation: surgeon-cut in the operating theatre, pre-cut and transported in a dextran-containing medium, and pre-cut and transported in a dextran-free medium.

Further categorisation occurred according to risk factors for graft transplantation, of which the primary factors were a previous vitrectomy, the presence of glaucoma drainage devices, and anterior segment malformations. A single surgeon performed all surgeries in the study.

In all, 265 DSAEK surgeries were performed on 240 patients. Out of the total number of surgeries performed, 135 used the surgeon-cut technique, 82 the pre-cut technique with dextran involvement, and 48 the pre-cut technique without dextran involvement.

The mean age of the patients and donors involved in the study was comparable. However, the pre-cut, dextran-free group showed an overrepresentation of female recipients and male donors. At 1.7%, patients with risk factors were also overrepresented in this group.

A significantly higher detachment rate was found among patients receiving pre-cut grafts transported in a dextran-containing medium (32.9%) compared to surgeon-cut grafts (14.1%) and pre-cut grafts transported in a dextran-free medium (6.3%). The findings applied to all graft recipients, including those with and without risk factors for graft detachment.

Dr Olafsdottir noted that similar results are only encountered in adolescent patients without any known risk factors, which she said makes the findings very statistically significant.

From these findings, Dr Olafsdottir suggested that using pre-cut DSAEK tissue transported in a dextran-containing medium should be excluded from clinical consideration due to the high detachment rate. She explained that this could be due to dextran being a polysaccharide with viscous properties, which may affect tissue adhesion, although further investigation is required.

Dr Olafsdottir presented at the 2025 EuCornea congress in Prague.

Thorbjörg Olafsdottir MD is a clinical researcher at Lund University, Sweden. thorbjorg.olafsdottir@med.lu.se