Association between corneal storage media and graft dislocation following Descemet stripping automated endothelial keratoplasty: a retrospective comparative cohort analysis
Authors: Andre S. Pollmann1, Jayme Vianna1, Christopher D. Seamone1, Stanley P. George1, Elsie Chan2, Darrell Lewis1. 1Dalhousie University, 2Royal Victoria Eye and Ear Hospital.
Author Disclosure Block: A.S. Pollmann: None. J. Vianna: None. C.D. Seamone: None. S.P. George:
None. E. Chan: None. D. Lewis: None.
Title: Association between corneal storage media and graft dislocation following Descemet stripping automated endothelial keratoplasty: a retrospective comparative cohort analysis
Purpose: Previous studies have suggested multiple risk factors for graft dislocation following Descemet stripping automated endothelial keratoplasty (DSAEK), including hypothermic storage medium. This could have significant implications for eye banking practices in Canada, where eye banks prepare DSAEK tissue for transplantation exclusively in hypothermic storage medium. We sought to investigate the risk factors for graft dislocation following DSAEK, including corneal tissue storage medium.
Study Design: Retrospective cohort analysis.
Methods: Study sites consisted of the QEII Health Sciences Center, Halifax, Nova Scotia, Canada (hypothermic storage media cohort) and the Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia (organ culture media cohort). Patient, surgical, and post-operative data were collected for consecutive DSAEK surgeries performed for any indication between 2012 and 2020. Risk factors were analyzed using univariable and multivariable logistic regression modeling.
Results: In total, 654 DSAEK surgeries were performed during the study period: 271 in the hypothermic storage cohort and 383 in the organ culture storage cohort. The most common indications were pseudophakic bullous keratopathy, Fuchs endothelial corneal dystrophy, and failed previous DSAEK graft. The incidence of graft dislocation requiring surgical repositioning was 9.96% (n=26) in the hypothermic storage media cohort and 12.1% (n=46) in the organ culture media cohort (OR 0.51, 95% CI 0.21-1.1). Graft dislocation occurred a mean of 3.35 days (range 0-35) following surgery. Statistically significant risk factors for graft dislocation in the multivariable logistic regression model included presence of post-operative wound leak (OR 54.59, 95% CI 10.08-508.33), lower donor endothelial cell density (OR 0.92, 95% CI 0.84-0.99 per 100 cells higher), and creation of intraoperative venting incisions (OR 2.49, 95% CI 1.12-5.48). A history of medical or surgically managed glaucoma, presence of an anterior chamber intraocular lens, and graft insertion technique were not associated with dislocation.
Conclusions: The incidence of DSAEK detachment was similar between hypothermic storage media and organ culture media cohorts. Wound leaks, venting incisions, and lower donor endothelial cell density were predictors associated with graft detachment.