Prelamellar Dissection Donor Corneal Thickness Is Associated With Descemet Stripping Automated Endothelial Keratoplasty Operative Complications in the Cornea Preservation Time Study

Cornea Preservation Time Study Group

Research output: Contribution to journalArticle

Abstract

PURPOSE: To identify donor and recipient factors, including eye bank tissue observations, predictive of operative complications in the Cornea Preservation Time Study. METHODS: One thousand three hundred thirty study eyes undergoing Descemet stripping automated endothelial keratoplasty for Fuchs dystrophy or pseudophakic/aphakic corneal edema were randomized to receive a donor cornea with preservation time (PT) of 0 to 7 days (N = 675) or 8 to 14 days (N = 655). Donor factors included demographics, prelamellar corneal and postlamellar lenticule dissection thickness, central endothelial cell density, and tissue processing time. Recipient factors included demographics, intraocular pressure, and glaucoma medications or surgery (trabeculectomy, laser trabeculoplasty). Eye bank observations included donor tissue folds, pleomorphism/polymegethism, and endothelial cell abnormalities. Possible tissue-related operative complications were recorded including difficult donor lenticule unfolding and positioning. Multivariable logistic regression with backward selection was used to identify statistically significant (P < 0.01) associations between factors and operative complications. RESULTS: The only factor predictive of operative complications [58 (4.4%) of 1330 surgeries] was prelamellar dissection donor corneal thickness (P = 0.002). For every 50 μm of donor corneal thickness prior to lamellar dissection, operative complication odds increased by 40% (odds ratio [99% confidence interval (CI)]: 1.40 [1.06-1.83]) adjusting for PT and whether the epithelium was on or off. The estimated mean prelamellar dissection donor corneal thickness for PT 0 to 7 days was 537 μm (99% CI: 516 μm-558 μm) compared with 567 μm (99% CI: 546 μm-588 μm) for PT 8 to 14 days (P < 0.001). CONCLUSIONS: Thicker donor tissue (prelamellar dissection) is associated with operative complications and should be considered in tissue selection for Descemet stripping automated endothelial keratoplasty lenticule preparation.

Original languageEnglish (US)
Pages (from-to)1069-1076
Number of pages8
JournalCornea
Volume38
Issue number9
DOIs
StatePublished - Sep 1 2019
Externally publishedYes

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Descemet Stripping Endothelial Keratoplasty
Time and Motion Studies
Cornea
Dissection
Eye Banks
Trabeculectomy
Confidence Intervals
Endothelial Cells
Fuchs' Endothelial Dystrophy
Demography
Tissue Donors
Corneal Edema
Laser Therapy
Intraocular Pressure
Glaucoma
Endothelium
Epithelium
Cell Count
Logistic Models
Odds Ratio

ASJC Scopus subject areas

  • Ophthalmology

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Prelamellar Dissection Donor Corneal Thickness Is Associated With Descemet Stripping Automated Endothelial Keratoplasty Operative Complications in the Cornea Preservation Time Study. / Cornea Preservation Time Study Group.

In: Cornea, Vol. 38, No. 9, 01.09.2019, p. 1069-1076.

Research output: Contribution to journalArticle

@article{6744e39c0ef445a99fc8f686f2db454d,
title = "Prelamellar Dissection Donor Corneal Thickness Is Associated With Descemet Stripping Automated Endothelial Keratoplasty Operative Complications in the Cornea Preservation Time Study",
abstract = "PURPOSE: To identify donor and recipient factors, including eye bank tissue observations, predictive of operative complications in the Cornea Preservation Time Study. METHODS: One thousand three hundred thirty study eyes undergoing Descemet stripping automated endothelial keratoplasty for Fuchs dystrophy or pseudophakic/aphakic corneal edema were randomized to receive a donor cornea with preservation time (PT) of 0 to 7 days (N = 675) or 8 to 14 days (N = 655). Donor factors included demographics, prelamellar corneal and postlamellar lenticule dissection thickness, central endothelial cell density, and tissue processing time. Recipient factors included demographics, intraocular pressure, and glaucoma medications or surgery (trabeculectomy, laser trabeculoplasty). Eye bank observations included donor tissue folds, pleomorphism/polymegethism, and endothelial cell abnormalities. Possible tissue-related operative complications were recorded including difficult donor lenticule unfolding and positioning. Multivariable logistic regression with backward selection was used to identify statistically significant (P < 0.01) associations between factors and operative complications. RESULTS: The only factor predictive of operative complications [58 (4.4{\%}) of 1330 surgeries] was prelamellar dissection donor corneal thickness (P = 0.002). For every 50 μm of donor corneal thickness prior to lamellar dissection, operative complication odds increased by 40{\%} (odds ratio [99{\%} confidence interval (CI)]: 1.40 [1.06-1.83]) adjusting for PT and whether the epithelium was on or off. The estimated mean prelamellar dissection donor corneal thickness for PT 0 to 7 days was 537 μm (99{\%} CI: 516 μm-558 μm) compared with 567 μm (99{\%} CI: 546 μm-588 μm) for PT 8 to 14 days (P < 0.001). CONCLUSIONS: Thicker donor tissue (prelamellar dissection) is associated with operative complications and should be considered in tissue selection for Descemet stripping automated endothelial keratoplasty lenticule preparation.",
author = "{Cornea Preservation Time Study Group} and Ross, {Kevin W.} and Stoeger, {Christopher G.} and Rosenwasser, {George O.D.} and OʼBrien, {Robert C.} and Szczotka-Flynn, {Loretta B.} and Ayala, {Allison R.} and Maguire, {Maureen G.} and Benetz, {Beth Ann} and Patricia Dahl and Drury, {Donna C.} and Dunn, {Steven P.} and Farazdaghi, {Sameera M.} and Hoover, {Caroline K.} and Macsai, {Marian S.} and Mian, {Shahzad I.} and Nordlund, {Michael L.} and Penta, {Jeffrey G.} and Soper, {Mark C.} and Terry, {Mark A.} and Verdier, {David D.} and Williams, {Doyce V.} and Lass, {Jonathan H.}",
year = "2019",
month = "9",
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doi = "10.1097/ICO.0000000000002040",
language = "English (US)",
volume = "38",
pages = "1069--1076",
journal = "Cornea",
issn = "0277-3740",
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T1 - Prelamellar Dissection Donor Corneal Thickness Is Associated With Descemet Stripping Automated Endothelial Keratoplasty Operative Complications in the Cornea Preservation Time Study

AU - Cornea Preservation Time Study Group

AU - Ross, Kevin W.

AU - Stoeger, Christopher G.

AU - Rosenwasser, George O.D.

AU - OʼBrien, Robert C.

AU - Szczotka-Flynn, Loretta B.

AU - Ayala, Allison R.

AU - Maguire, Maureen G.

AU - Benetz, Beth Ann

AU - Dahl, Patricia

AU - Drury, Donna C.

AU - Dunn, Steven P.

AU - Farazdaghi, Sameera M.

AU - Hoover, Caroline K.

AU - Macsai, Marian S.

AU - Mian, Shahzad I.

AU - Nordlund, Michael L.

AU - Penta, Jeffrey G.

AU - Soper, Mark C.

AU - Terry, Mark A.

AU - Verdier, David D.

AU - Williams, Doyce V.

AU - Lass, Jonathan H.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - PURPOSE: To identify donor and recipient factors, including eye bank tissue observations, predictive of operative complications in the Cornea Preservation Time Study. METHODS: One thousand three hundred thirty study eyes undergoing Descemet stripping automated endothelial keratoplasty for Fuchs dystrophy or pseudophakic/aphakic corneal edema were randomized to receive a donor cornea with preservation time (PT) of 0 to 7 days (N = 675) or 8 to 14 days (N = 655). Donor factors included demographics, prelamellar corneal and postlamellar lenticule dissection thickness, central endothelial cell density, and tissue processing time. Recipient factors included demographics, intraocular pressure, and glaucoma medications or surgery (trabeculectomy, laser trabeculoplasty). Eye bank observations included donor tissue folds, pleomorphism/polymegethism, and endothelial cell abnormalities. Possible tissue-related operative complications were recorded including difficult donor lenticule unfolding and positioning. Multivariable logistic regression with backward selection was used to identify statistically significant (P < 0.01) associations between factors and operative complications. RESULTS: The only factor predictive of operative complications [58 (4.4%) of 1330 surgeries] was prelamellar dissection donor corneal thickness (P = 0.002). For every 50 μm of donor corneal thickness prior to lamellar dissection, operative complication odds increased by 40% (odds ratio [99% confidence interval (CI)]: 1.40 [1.06-1.83]) adjusting for PT and whether the epithelium was on or off. The estimated mean prelamellar dissection donor corneal thickness for PT 0 to 7 days was 537 μm (99% CI: 516 μm-558 μm) compared with 567 μm (99% CI: 546 μm-588 μm) for PT 8 to 14 days (P < 0.001). CONCLUSIONS: Thicker donor tissue (prelamellar dissection) is associated with operative complications and should be considered in tissue selection for Descemet stripping automated endothelial keratoplasty lenticule preparation.

AB - PURPOSE: To identify donor and recipient factors, including eye bank tissue observations, predictive of operative complications in the Cornea Preservation Time Study. METHODS: One thousand three hundred thirty study eyes undergoing Descemet stripping automated endothelial keratoplasty for Fuchs dystrophy or pseudophakic/aphakic corneal edema were randomized to receive a donor cornea with preservation time (PT) of 0 to 7 days (N = 675) or 8 to 14 days (N = 655). Donor factors included demographics, prelamellar corneal and postlamellar lenticule dissection thickness, central endothelial cell density, and tissue processing time. Recipient factors included demographics, intraocular pressure, and glaucoma medications or surgery (trabeculectomy, laser trabeculoplasty). Eye bank observations included donor tissue folds, pleomorphism/polymegethism, and endothelial cell abnormalities. Possible tissue-related operative complications were recorded including difficult donor lenticule unfolding and positioning. Multivariable logistic regression with backward selection was used to identify statistically significant (P < 0.01) associations between factors and operative complications. RESULTS: The only factor predictive of operative complications [58 (4.4%) of 1330 surgeries] was prelamellar dissection donor corneal thickness (P = 0.002). For every 50 μm of donor corneal thickness prior to lamellar dissection, operative complication odds increased by 40% (odds ratio [99% confidence interval (CI)]: 1.40 [1.06-1.83]) adjusting for PT and whether the epithelium was on or off. The estimated mean prelamellar dissection donor corneal thickness for PT 0 to 7 days was 537 μm (99% CI: 516 μm-558 μm) compared with 567 μm (99% CI: 546 μm-588 μm) for PT 8 to 14 days (P < 0.001). CONCLUSIONS: Thicker donor tissue (prelamellar dissection) is associated with operative complications and should be considered in tissue selection for Descemet stripping automated endothelial keratoplasty lenticule preparation.

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U2 - 10.1097/ICO.0000000000002040

DO - 10.1097/ICO.0000000000002040

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AN - SCOPUS:85071349786

VL - 38

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JO - Cornea

JF - Cornea

SN - 0277-3740

IS - 9

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