1. DSAEK using corneas with previous LASIK
ME Légaré, MD; W Sansanayudh, MD
NL Kumar, MD FRANZCO; R Shehadeh- Mashor, MD
AR Slomovic, MA MD FRCSC; DS Rootman, MD FRCSC
Department of Ophthalmology
Toronto Western Hospital
University of Toronto
The authors have no financial interest
Submission Number: 642

2. Introduction
Penetrating keratoplasty (PKP) used to be the standard of care for corneal endothelial failure
Endothelial keratoplasty (EK) progressively gains popularity with evidence based data
The Eye Banks of America and Canada exclude corneas with anterior scars and refractive surgeries for PKP
EK allows for anteriorly flawed donor corneas to still be used for endothelial failure
Also, we can expect an increasing number of donors with previous refractive surgery therefore not suitable for PKP
Melles & al , Tan & al. 2008, Philipps & al 2009

3. Purpose To evaluate the perioperative, short-term
safety and efficacy of DSAEK using donor
buttons with previous LASIK.

4. Study design
A retrospective, consecutive, non-randomized interventional short case series
Department of Ophthalmology
University Health Network
Toronto Western Hospital
Toronto, Ontario, Canada

5. methods
The medical records of 5 patients/5 eyes with endothelial failure who underwent DSAEK using donors with previous LASIK were reviewed
Data collected included pre and post surgical:
Uncorrected/best corrected vision (UCVA/BCVA)
Manifest refraction (MR)
Keratometric values
Endothelial cell count (ECC)
Central corneal thickness (CCT)
Peri-operative, short-term complications

6. Results: donors-demographics
Donors with LASIK
(N:5)
Donors for other DSAEK1
(N:17)
Age of donor
(years old)
57.4
(Range: )
52.7
(Range: )
ECC
(cells/mm2)
2559
(Range: )
2740
(Range: )
CCT
(μm)
490
(Range: 465 – 506)
Unknown
Donors with previous LASIK
Years post LASIK unknown
No interface haze, no scar in all donors
1-Amiran & al. WCCVI 2010

7. Results: recipients demographics and interventions
Mean recipient age: 67 years old (Min: 62 Max: 77)

8. Results: donors-preparation
Button cut with a 300 μm microkeratome head:
(300 μm head is now routinely used after we had some perforations with other routine DSEAK preparation)
Cut was started on the hinge side of the LASIK flap
No LASIK flap displacement during the cut
No perforation during the cut
One self-sealing microperforation from a Sinsky hook during marking of the stromal side after the cut
Mean size of graft: 8.7 mm (Min:8.5 Max:9.0)

9. results Follow-up: 9 month:3 eyes 6 months:2 eyes
UCVA and BCVA improved in all cases
Mean CCT at 6 months was: 586 μm
Mean ECC loss at 6 months: 45.53%

10. Results:

11. conclusion Donors with previous LASIK had an adequate ECC
ECC loss at 6 months was higher than the % in other studies but based on only 3 eyes
No complications were reported during the button cut
Starting the button cut at the hinge kept the LASIK flap stable in all cases
These donor corneas might create thinner buttons