Ultra-thin DSAEK using an innovative artificial anterior chamber pressuriser: a proof-of-concept study

Purpose: To report the impact of establishing and maintaining a high intracameral pressure (ICP) of 200 mmHg on UT-DSAEK graft preparation using an artificial anterior chamber pressuriser (ACP) control unit (Moria SA, Antony, France). Method: Retrospective laboratory and clinical study. Four paired donor corneas were mounted on an artificial anterior chamber and subjected to 70 mmHg (“low”) and 200 mmHg (“high”) ICP using an ACP system. The central corneal thinning rate was measured after 5 min using AS-OCT and the endothelial cell viability was analysed using trypan blue and live/dead staining following 70 mmHg and 200 mmHg ICP. Visual outcomes and complications in a clinical case series of nine patients with bullous keratopathy who underwent UT-DSAEK using 200 mmHg ICP during graft preparation are reported. Results: Laboratory outcomes showed 2 ± 1% and 2 ± 2% dead cells following 70 mmHg and 200 mmHg ICP respectively. Percentage viability in the 70 mmHg group (52.94 ± 5.88%) was not found to be significantly different (p = 0.7) compared to the 200 mmHg group (59.14 ± 10.43%). The mean corneal thinning rate after applying 200 mmHg ICP was 27 ± 13 μm/min centrally (7.2%/min). In the clinical case series, two cases were combined with cataract surgery. Re-bubbling rate was 11%. At the last follow-up (259 ± 109 days), graft thickness was 83 ± 22 μm centrally, endothelial cell density was 1175 ± 566 cell/mm2 and the BCVA of 0.08 ± 0.12 logMAR was recorded with no episodes of rejection. Conclusion: ACP control unit for UT-DSAEK graft preparation helps in consistently obtaining UT-DSAEK grafts without compromising endothelial cell viability.