Eye bank and clinical outcomes of pre-cut corneal tissue for Descemet's stripping automated endothelial keratoplasty using Gebauer SLc microkeratome system

Session Details

Session Title: Cornea: Surgical I

Session Date/Time: Tuesday 08/09/2015 | 08:00-10:30

Paper Time: 08:42

Venue: Room 10

First Author: : N.Sabater-Cruz SPAIN

Co Author(s): :    J. Torras   R. Casaroli-Marano   J. Matas   E. Martinez-Conesa   N. Otero   E. Agusti     

Abstract Details

Purpose:

To evaluate the Eye bank outcomes of pre-cut corneal tissue with the use of Gebauer SLc microkeratome system in terms of tissue quality and waste and its correlation with clinical outcomes as visual acuity (BCVA) and graft primary failure (GPF), in a tertiary, teaching hospital during a 3-year period.

Setting:

Retrospective, consecutive, interventional case series from pre-cut corneal tissue (PCT) prepared in the Barcelona Tissue Bank (BTB-BST) Ocular Tissue Bank, and Descemet Stripping Automated Endothelial Keratoplasties (DSAEK) performed by cornea surgeons in the Hospital Clinic de Barcelona (HCB, Barcelona, Spain).

Methods:

Corneas aimed to posterior lamellar surgery were prepared in the eye bank using the Gebauer SLc microkeratome system. Quality standards were studied and those not reaching them were discarded. Two periods were evaluated: phase 1, between 1/1/2012 and 15/1/2013 in which pre-cut tissues were obtained with 400 to 450 µm pre-mounted blades; and phase 2, between 16/1/2013 to 31/12/2014 using 400 to 600 µm pre-mounted blades. Discarded corneas and incidents detected during cut were recorded for both periods. Complications and clinical outcomes of DSAEK were recorded and compared with negative feedback survey from all BTB pre-cut tissue implanting hospitals.

Results:

Phase 1 included 56 of 282 corneas: 4 had inappropriate pachymetry (after a second cut, 2 were perforated) and 3.6% were perforated primarily. Phase 2 included 226 corneas: 2.2% were perforated (2 of them after a second cut) and 1.8% were spoiled during the process. Twelve DSAEK were carried out in phase 1 and 40 in phase 2. Previous BCVA was similar in both groups. GPF was 25% in phase 1 and 22.5% in phase 2. Final BCVA was 0.41 in phase 1 and 0.44 in phase 2. BTB had a complete feedback of 63 corneas and only 2 reported GPF.

Conclusions:

This study showed the outcomes of Eye bank PCT implantation. Despite the 4 corneas spoiled in phase 2, more tissue was discharged in phase 1 (p<0,01). That could be explained by learning curve and showed similar figures in literature. GPF can be explained by surgical manipulation, chronic dislocation and quality of PCT. The poor response to the survey hinders to relate cases of primary failure to BTB causes. Final BCVA was similar between phases (p<0,05). PCT from the BTB does not show increased risk of complications due to tissue preparation. It increases surgeon efficiency and saves surgical time.

Financial Interest:

One of the authors travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented