PurposeTo optimize methods of preparing donor cornea tissue for Descemet's stripping automated endothelial keratoplasty (DSAEK), we compared five experimental conditions with different internal pressures and cutting systems.MethodsThe artificial anterior chamber internal pressure (IP) was set at 100 or 200 mm Hg. The microkeratome cut was performed with or without an artificial chamber pressurizer (ACP), using a CBm turbine (CBm) or one use-plus automated (OUP-A). Thirty human research corneas were divided into five groups, and compared after the cut with donor tissue quality parameters, including cutting depth, graft uniformity, cell evaluation, and smoothness of the stromal surface.ResultsThe smallest variation in mean cut depth was observed in the condition, which had IP of 200 mm Hg used ACP and OUP-A. In experimental groups cut using CBm, significantly more consistent thicknesses were made at an IP of 200 than 100 mm Hg. There were no statistically significant differences among the groups in either endothelial cell density or cell viable assay results after cuts. Using an IP of 200 mm Hg with ACP and CBm produced the roughest stromal surface, and the roughness grading scores showed a positive correlation with the percentage of cut depth.ConclusionsAn IP of 200 mm Hg was the best setting for DSAEK grafts with high predictability of cut depth and uniformity of graft thickness without endothelial cell damage.Translational RelevanceFor successful DSAEK, it is recommended that a set internal pressure of 200 mm Hg be used during microkeratome cutting for donor tissue preparation.
Purpose To evaluate the association between total protein and cytokine levels in aqueous humor (AqH) and the progression of peripheral anterior synechiae (PAS) after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods This prospective study included 146 consecutive patients who underwent DSAEK. Preoperative levels of total protein and 20 cytokines in AqH were measured. Using three-dimensional anterior segment optical coherence tomography, we assessed the iridotrabecular contact (ITC) area before and at 3, 6, and 12 months after DSAEK. Correlations between the total protein and cytokine levels in the AqH and ITC area were analyzed. Results ITC was observed in 47 eyes (32.2%) after DSAEK. The ITC area increased from 2.00 ± 4.42 mm 2 preoperatively to 3.00 ± 6.85 mm 2 at 12 months. The total protein level in AqH was significantly higher in eyes with ITC progression than in those without (1.45 ± 1.03 mg/mL vs. 1.00 ± 0.57; P = 0.04) and was significantly positively correlated with the progression of ITC area after DSAEK (at 6 months, r = 0.311 and P = 0.005; at 12 months, r = 0.342 and P = 0.0004). The ITC area at 12 months was significantly correlated with the preoperative AqH levels of interleukin-8 ( r = 0.252; P = 0.021), interferon-γ ( r = 0.318; P = 0.009), and soluble intercellular adhesion molecule-1 ( r = 0.292; P = 0.004). Multivariate analyses showed that the total protein levels in AqH and the presence of preoperative ITC were significant risk factors for increased ITC area after DSAEK (β = 0.193–0.574; all P < 0.02). Conclusions Higher preoperative total protein and specific cytokine levels in AqH were associated with ITC formation after DSAEK. Translational Relevance Our findings indicate that chronic pathological changes in AqH can cause PAS progression and glaucoma after DSAEK.
Peripheral anterior synechiae (PAS) after corneal transplantation leads to refractory glaucoma and permanent loss of vision. However, the exact mechanism remains elusive. This study aimed to evaluate the association between cytokine levels in the aqueous humor (AqH) and the progression of PAS after penetrating keratoplasty (PKP). We measured 20 cytokine levels in AqH and assessed the correlation with PAS progression after PKP in 85 consecutive patients who underwent PKP. We also evaluated age-dependent alterations in PAS and cytokine levels in DBA2J mice. PAS developed in 38 (44.7%) of 85 eyes after PKP. The incidence of intraocular pressure increase after PKP was significantly greater in eyes with PAS (26.3%) than in those without PAS (2%, p = 0.0009). The PAS area at 12 months after PKP was significantly positively correlated with the preoperative levels of interleukin (IL)-6, interferon (IFN)-γ and monocyte chemotactic protein (MCP)-1 (p ≤ 0.049). In the DBA2J mice, an experimental glaucoma model that developed PAS at 50 weeks, the AqH levels of IL-2, IL-6, IL-10, IFN-γ, tumor necrosis factor-α, MCP-1 and granulocyte-macrophage colony-stimulating factor (GM-CSF) significantly increased at 50 weeks compared to 8 weeks (p ≤ 0.021). In conclusion, inflammatory alterations in the AqH microenvironment, such as high preoperative specific cytokine levels, can lead to PAS formation and glaucoma.
AimsTo identify donor-related risk factors associated with graft endothelial failure and postoperative endothelial cell density (ECD) reduction after Descemet's stripping automated endothelial keratoplasty (DSAEK).MethodsThis was a single-center retrospective study conducted from July 2006-December 2016. We included 584 consecutive eyes (482 patients) that underwent DSAEK for the treatment of laser iridotomy-related bullous keratopathy (192 eyes), pseudophakic bullous keratopathy (137 eyes), regraft (96 eyes), Fuchs' endothelial corneal dystrophy (FECD; 59 eyes) and others (100 eyes). Twenty-three donor- and recipient-related risk factors potentially associated with graft failure and ECD reduction were assessed using Cox hazard models and linear mixed effect models.ResultsThe median age of the patients was 73.5 years (male; 35.6%). After DSAEK, ECD decreased from 2,674 cells/mm2 (95% confidence interval [CI]; 2,646–2,701) to 1,132 (1,076–1,190) at 12 months and 904 (845–963) at 24 months (P < 0.001). Fifty-five eyes (9.4%) had graft endothelial failure without rejection. This failure was associated with donor pseudophakic lens status (hazard ratio [HR]; 2.67, CI; 1.50–4.76, P = 0.001) and preoperative endothelial folds (HR; 2.82, CI; 1.20–6.62, P = 0.02). The incidence of graft endothelial failure in non-FECD patients was significantly higher among those receiving donor grafts with a pseudophakic lens status and preoperative presence of endothelial folds (P < 0.001). Postoperative ECD loss was significantly greater in eyes with these risk factors compared to those without (P = 0.007).ConclusionsPseudophakic status and/or presence of preoperative endothelial folds are the significant donor risk factors for endothelial failure in non-FECD patients.
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