Purpose: To determine if donor graft diameter has a relationship with postoperative central endothelial cell density (ECD) and survival in Descemet's stripping automated endothelial keratoplasty (DSAEK). Design: Retrospective, comparative analysis of an interventional case series. Participants: Three hundred thirty-one eyes of 243 patients undergoing DSAEK surgery for Fuchs' endothelial dystrophy without a history of rejection or graft dislocation. Methods: Descemet's stripping automated endothelial keratoplasty was performed in 331 eyes with Fuchs' dystrophy. After exclusion of confounding variables, postoperative ECD and percentage cell loss was compared for 8.0-mm grafts (n = 154) versus 8.5-mm grafts (n = 165) over a 2-year postoperative period. Main Outcome Measures: Total central ECD and percentage of donor endothelial cell loss as measured by specular microscopy of central ECD. Results: Mean preoperative ECD was 2635 cells/mm 2 for 8.0-mm grafts and 2732 cells/mm 2 for 8.5-mm grafts (P = 0.003). Mean ECD (and percent cell loss from before surgery) was 2011 cells/mm 2 (22.9%) for 8.0-mm grafts and 2078 cells/mm 2 (23.5%) for 8.5-mm grafts at 6 months, 2009 cells/mm 2 (23.3%) and 2113 cells/mm 2 (23.1%) at 1 year, and 2060 cells/mm 2 (23.4%) and 2111 cells/mm 2 (24.3%) at 2 years (P>0.72 for percentage cell loss at all time points). Conclusions: Descemet's stripping automated endothelial keratoplasty grafts with a diameter of 8.5 mm do not offer a clinical advantage over smaller 8.0-mm grafts for postoperative endothelial cell counts in the first 2 years after surgery. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
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