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Indian J Ophthalmol. 2019 Aug;67(8):1289-1294. doi: 10.4103/ijo.IJO_1660_18.

Microkeratome-assisted ultrathin Descemet's stripping automated endothelial keratoplasty: A randomized trial comparing single-pass versus double-pass technique.

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Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.



To compare the outcomes of two techniques, for preparation of microkeratome-assisted ultrathin grafts for Descemet's stripping automated endothelial keratoplasty (DSAEK).


The study involved 20 eyes of 20 patients with pseudophakic bullous keratopathy, randomized into two groups. Group 1 eyes underwent microkeratome-assisted DSAEK using the single-pass technique for lenticule preparation, whereas group 2 eyes underwent microkeratome-assisted DSAEK using the double-pass technique. Patients were followed up till 6 months, postoperatively. Best-corrected visual acuity (BCVA) at final follow-up was considered as the primary outcome measure, whereas graft thickness (GT) contrast sensitivity and endothelial cell loss were considered as the secondary outcome measures. A P value of <0.05 was considered as statistically significant.


Baseline characteristics of two groups were comparable. The mean central GT was comparable in both groups at 6 months follow-up [group 1: 98 ± 24.46 μm, group 2: 129 ± 31.46 μm (P = 0.18)]. Both groups fared equally in terms of BCVA (P = 0.33). Contrast sensitivity was significantly better in group 1 eyes (P = 0.045). A statistically significant negative correlation was found between postoperative BCVA and postoperative GT (R = -0.728, P = 0.016). The percentage endothelial cell loss was slightly higher in group 2 eyes, although not statistically significant. Two eyes in group 2 experienced complications during lenticule preparation. None of the eye experienced any complication in the postoperative period.


Both techniques provided grafts with comparable thickness and endothelial cell loss and were associated with comparable BCVA, at final follow-up visit. The contrast sensitivity was, however, better in eyes receiving grafts prepared with the single-pass technique.


Double-pass technique; microkeratome; single-pass technique; ultrathin Descemet's stripping automated endothelial keratoplasty

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