Visual Outcomes and Graft Thickness in Microthin DSAEK--One-Year Results.

To evaluate visual outcomes, endothelial graft thickness, and complications in microthin Descemet stripping automated endothelial keratoplasty (DSAEK).A prospective interventional cohort of 130 eyes of 114 consecutive patients underwent microthin DSAEK. Endothelial graft preparation included pachymetry-controlled stromal dehydration to reduce donor thickness between 550 and 530 μm by a custom airflow device, before a single-pass microkeratome dissection with a uniform cutting head of 350 μm to achieve microthin endothelial grafts (<130 μm). Data on visual acuity, graft thickness, endothelial cell loss, and complication rates were analyzed.Pachymetry-controlled donor preconditioning reduced donor thickness on average by 67 μm (range 0-186, SD 44.7) from 590 μm (range 485-806, SD 53) to 528 μm (range 480-620, SD 23), P < 0.01, and allowed graft preparation without any case of intraoperative graft loss or perforation. The resultant mean graft thickness was 94 μm (SD 25) intraoperatively, 94 μm (SD 26) at 1 month, and 90 μm (SD 19) at 12 months. Of note, 98.2% of eyes without significant visual comorbidity achieved best-corrected Snellen acuity of 6/9 or more at 12 months. There was a 35.8% and 41% reduction in endothelial cell density at 3 and 12 months, respectively. Postoperative graft detachment occurred in 5% of cases (1.7% in uncomplicated eyes). There was no graft loss during preparation, and none developed immune rejection during the study period.The microthin DSAEK procedure offers a simple and safe technique to prepare thin endothelial grafts with a low risk of graft wastage, low risk of postoperative detachment, and visual results that are comparable to those of other thin endothelial keratoplasty procedures.