Descemet’s stripping and non-Descemet’s stripping automated endothelial keratoplasty for microcornea using 6.0 mm donor grafts

Hideaki Yokogawa,¹ Akira Kobayashi,¹ Natsuko Yamazaki,¹ Yoshiki Ueta,² Yoshihiro Hashimoto,² Naoko Tachi,² Kazuhisa Sugiyama<sup>1

1</sup>Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, ²Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu-shi, Japan

Background: The purpose of this paper is to report our experience of Descemet’s stripping and non-Descemet’s stripping automated endothelial keratoplasty (DSAEK/nDSAEK) for microcorneas using 6.0 mm donor grafts.
Methods: Three eyes of two patients (a 56-year-old woman and a 59-year-old woman) with microcornea and suffering from bullous keratopathy were treated with either DSAEK or nDSAEK. A small donor graft (6.0 mm) was inserted into the anterior chamber using a double glide (Busin glide and intraocular lens sheet glide) donor insertion technique. Both patients were followed for at least 12 months. Clinical outcomes, including intraoperative and postoperative complications, visual acuity, and endothelial cell density were evaluated.
Results: In all three cases (100%), no intraoperative complications were noted. In one case with a flat keratometry value (32.13 D), a partial donor detachment was noted one day postoperatively, but it was reattached by rebubbling. In another case, rejection was noted 8 months postoperatively, but treatment with systemic corticosteroids was successful. A clear cornea remained in all three cases (100%), with best-corrected visual acuity greater than 20/100 (mean 20/50) at 12 months. Mean postoperative endothelial cell counts were 2,603 ± 18 cells/mm² at 6 months (7.4% decrease from preoperative donor cell counts) and 1,799 ± 556 cells/mm² at 12 months (36.5% decrease).
Conclusion: We report for the first time the successful use of a small donor graft (6.0 mm) for DSAEK/nDSAEK in cases of microcornea. Additional studies using a large number of patients are required to evaluate fully the potential advantages and drawbacks of small diameter donor grafts for microcornea.

Keywords: microcornea, Descemet’s stripping, non-Descemet’s stripping, automated endothelial keratoplasty, small donor grafts