1. Lori Lombardi MD, Mark A. Terry MD, Neda Shamie MD, Anand K. Shah MD, Daniel J. Friend MS *Dr. Terry has a financial interest in Bausch & Lomb instruments he developed for DSAEK Other authors have no financial interest

2.  DSAEK surgery has revolutionized treatment for various forms of corneal endothelial dysfunction  Successful replacement of damaged endothelium with graft tissue relies on surgical technique as well as favorable tissue characteristics  Previously, surgeons prepared the donor posterior lenticule at the time of surgery  Now, “precut” donor tissue may be prepared by the tissue bank using a Moria microkeratome and artificial anterior chamber system

3.  This large scale, prospective study compares outcomes of DSAEK surgery using surgeon-cut versus pre-cut donor tissue

4.  Patients were enrolled in an Institutional Review Board approved protocol for endothelial keratoplasty  Surgical data was gathered in a prospective fashion  Consecutive DSAEK surgeries were compared using Surgeon-cut tissue (n=114) versus Pre-cut tissue (n=207).  Outcome measures reviewed include:  Best spectacle corrected visual acuity (BSCVA)  Endothelial cell loss  Rate of primary graft failure  Graft dislocation rate

5.  Average BSCVA at 6 months:  20/37 for the Surgeon-cut group (n=114)  20/38 for the Pre-cut group (n=207)  p = 0.745  Average BSCVA at 1 year:  20/33 for the Surgeon-cut (n=108)  20/42 for the Pre-cut (n=112)  p = 0.044  With comorbidities removed, BSCVA at 1 year:  20/33 for the Surgeon-cut (n=106)  20/41 for Pre-cut (n=108)  p = 0.72

7.  Endothelial cell loss at 6 months:  Surgeon-cut = 35%  Pre-cut = 29%  p=0.002  Endothelial cell loss at 1 year:  Surgeon-cut = 36%  Pre-cut = 29%  p = 0.009

9.  Primary graft failures:  No primary graft failures occurred in either group  Dislocations:  Two dislocations occurred in the Surgeon-cut group  Ten dislocations in the Pre-cut group  p=0.421

10.  In this large-scale, prospective study, DSAEK using either Surgeon-cut or Pre-cut tissue resulted in comparable patient outcomes and surgical results  BSCVA was not statistically different between groups  Endothelial loss was higher in Surgeon-cut tissue  Dislocations occurred more often in the Pre-cut group  Study includes graft preparation and surgery performed by less experienced surgeons, which may factor into the overall outcomes