Clinical Outcomes of Two Lenticule Thickness Types in Descemet Stripping Automated Endothelial Keratoplasty: One-Year Results.

Purpose: To compare clinical outcomes of eyes undergoing Descemet stripping automated endothelial keratoplasty (DSAEK) with 51-99 μm and <50 μm lenticules.

Methods: Retrospective, multi-center case series of 480 eyes undergoing DSAEK with precut tissue from a single eye bank between 2019 and 2022 performed by five surgeons at five centers. Eyes were divided into 51-99 μm or <50 μm groups according to post-cut graft thickness. The main outcome measure was inter-group comparison according to best-corrected distance visual acuity (BCDVA); additional outcome measures were primary graft failure (PGF), rebubbling, and cystoid macular edema (CME) rates in context of specific preoperative risk factors, intraoperative characteristics, and vision-limiting vs. non-vision-limiting morbidities.

Results: BCDVA at one year postoperatively was 0.5 ± 0.5 and 0.4 ± 0.4 logMAR for the 51-99 μm and <50 μm groups, respectively ( = 0.692). Regraft rate was 3.21% for 51-99 μm and 1.89% for <50 μm grafts ( = 0.4854). Rebubbling rate was 8.56% for the 51-99 μm group and 13.21% for the <50 μm group ( = 0.151). Analysis of rebubbled eyes showed no difference in rate of sulfur hexafluoride tamponade ( = 0.201), lenticule insertion method ( = 0.293), and glaucoma surgery history ( = 0.996). Higher rebubbling rates occurred in eyes with previous scleral-fixated intraocular lenses ( < 0.001). The effect of potential preoperative and intraoperative risk factors (e.g. insertion method ( = 0.979) and concurrent cataract surgery ( = 0.701)) on rebubbling was not significantly different between the two groups. CME rate was 4.01% for 51-99 μm and 7.54% for <50 μm groups ( = 0.131).

Conclusions: 51-99 μm and <50 μm DSAEK grafts offer similar visual outcomes. Both lenticule thicknesses have similar regrafting, rebubbling, and CME rates.