Article

Donor endothelial cell counts do not determine dislocation rates in EK

Preoperative donor endothelial cell count does not affect the rate of dislocation in endothelial keratoplasty. The surgical technique is likely the most important factor that drives the dislocation rate, primary graft failure rate, and long-term endothelial survival, according to one surgeon.

Key Points

Dr. Terry has experience with more than 500 cases of EK included in his institutional review board-approved prospective study. He performed the first EK in the United States in March 2000. Since then, variations of the surgical technique have been developed. As of spring 2007, Dr. Terry had performed about 275 cases of deep lamellar endothelial keratoplasty (DLEK), 32 cases of Descemet's stripping with endothelial keratoplasty (DSEK), and 225 cases of Descemet's stripping automated endothelial keratoplasty (DSAEK), including 80 cases in which pre-cut tissue was used.

Visual acuity results

"When we evaluated the approximately 100 DSAEK eyes that had 6 months of follow-up, the average VA was 20/37. Most importantly, if we eliminate the eyes with cystoid macular edema or age-related macular degeneration, 92% of the eyes that underwent DSAEK had 20/40 or better VA, 30% had 20/25 or better VA, and 12% had 20/20 or better VA, which is much better than we ever achieved with DLEK or penetrating keratoplasty," Dr. Terry said.

In addition to good VA results, the incidence of graft dislocation had decreased over time, he said.

"Initially, in our first 100 cases, we reported a 5% rate of dislocation with DLEK; however, as we performed more challenging cases with filtering tubes and IOL exchanges, the rate increased to 8% in 275 DLEK cases. The 32 cases of DSEK had a 6% rate (two cases) of dislocation. In the series of DSAEK cases, only three dislocations occurred among 223 cases, for a 1.3% dislocation rate," he said.

With those data in mind, Dr. Terry sought to determine which type of tissue to request from the eye bank.

"In the ideal world, the ideal tissue would be from a donor aged 25 years or younger, an endothelial cell count of 4,000 cells/mm2 or higher, and time from donor death to delivery to the operating room less than 1 hour while the tissue is still warm," he quipped.

Dr. Terry said that in the real world, however, he will accept tissue with an endothelial cell count ?2,000 cells/mm2 , a patient age <75 years, and a time since donor death 11 days.

"When we looked at the entire group of 532 cases for all EK procedures-the preoperative endothelial cell count in the 27 cases in which dislocation occurred compared with the 505 cases in which dislocation did not occur-preoperatively, there was no difference in the mean endothelial cell density," he said. "In fact, in eyes that did not dislocate, there was an endothelial cell count as low as 2,100 cells/mm2 , and in eyes in which dislocation occurred, the cell count was as high as 3,454 cells/mm2 . At least in this large series, dislocation did not depend on the preoperative endothelial cell count."

Newsletter

Don’t miss out—get Ophthalmology Times updates on the latest clinical advancements and expert interviews, straight to your inbox.

Related Videos
(Image credit: Ophthalmology Times)  ASCRS 2025: Joaquin De Rojas, MD, leverages machine learning model to predict arcuate outcomes
(Image credit: Ophthalmology Times) ASCRS 2025: AnnMarie Hipsley, DPT, PhD, presents VESA for biomechanical simulation of presbyopia progression
Shehzad Batliwala, DO, aka Dr. Shehz, discussed humanitarian ophthalmology and performing refractive surgery in low-resource, high-risk areas at the ASCRS Foundation Symposium.
(Image credit: Ophthalmology Times) ASCRS 2025: Advancing vitreous care with Inder Paul Singh, MD
(Image credit: Ophthalmology Times) The Residency Report: Study provides new insights into USH2A target end points
Lisa Nijm, MD, says preoperative osmolarity testing can manage patient expectations and improve surgical results at the 2025 ASCRS annual meeting
At the 2025 ASCRS Annual Meeting, Weijie Violet Lin, MD, ABO, shares highlights from a 5-year review of cross-linking complications
Maanasa Indaram, MD, is the medical director of the pediatric ophthalmology and adult strabismus division at University of California San Francisco, and spoke about corneal crosslinking (CXL) at the 2025 ASCRS annual meeting
(Image credit: Ophthalmology Times) ASCRS 2025: Taylor Strange, DO, assesses early visual outcomes with femto-created arcuate incisions in premium IOL cases
(Image credit: Ophthalmology Times) ASCRS 2025: Neda Shamie, MD, shares her early clinical experience with the Unity VCS system
© 2025 MJH Life Sciences

All rights reserved.