Influence of graft size on graft survival following Descemet stripping automated endothelial keratoplasty

Purpose To evaluate graft size on outcome following Descemet stripping automated endothelial keratoplasty (DSAEK) Methods Consecutive patients who had undergone a DSAEK for Fuchs endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK) with at least 1 year of follow-up. Patients were divided into three groups according to the size of the donor trephine: Results Of 174 patients, 131 were included: 84 (64%) with FED and 47 (36%) with PBK. Mean preoperative and postoperative BCVA were 1.01±0.76 and 0.2±0.2 logMAR, respectively, at 12 months with 80.5% achieving 20/40 or better. Postoperative BCVA was significantly associated with ECD (p=0.005), PBK or FED (p=0.004), risk factors (p=0.007) and comorbidity (p=0.016). Eleven patients (8.40%) experienced endothelial graft failure; 17.86% for Conclusions Larger grafts occupy a smaller chord length in the eye than the trephine size and are expected to provide 10%–20% more endothelial cells. Increased graft size and donor ECD is significantly associated with a reduced graft failure rate.