# Donor Characteristics in Graft Detachment after Posterior Lamellar Keratoplasty for Fuchs Endothelial Dystrophy and Bullous Keratopathy

## TL;DR

This study explores factors influencing graft detachment after eye surgery for corneal diseases, finding donor cause of death impacts outcomes.

## Contribution

The study identifies donor cause of death, particularly cardiovascular, as a novel factor affecting graft detachment in posterior lamellar keratoplasty.

## Key findings

- Graft detachment was more common in Fuchs endothelial dystrophy regardless of surgical technique.
- Donors with cardiovascular causes of death were linked to graft detachment in DMEK for Bullous keratopathy.
- Smaller graft diameters and steeper astigmatism reduced graft detachment risk in DSAEK for Bullous keratopathy.

## Abstract

Background: Descemet Membrane Endothelial Keratoplasty (DMEK) has been widely adopted to treat Fuchs endothelial dystrophy (FED) and Bullous keratopathy (BK). Graft detachment (GD) is one of the common earliest post-operatory complications, and it is usually recovered by Air Rebubbling (ARB). Methods: Retrospectively, we investigated predictive factors related to GD between January 2016 and March 2020, a pre-COVID era, in 72 patients, 72 eyes, and their donors’ lamellar characteristics, focusing on donor’s cause of death. The patients were divided according to the posterior lamellar keratoplasty technique adopted. Results: GD and consequent ARB were most common but not significantly prevalent in DMEK (p = 0.11). It was more common in FED for both surgical approaches. Only in BK treated with DSAEK were host steeper mean astigmatism (p = 0.03) and donors with smaller graft pre-cut diameters (p = 0.02) less likely to be related to GD. Regarding donor’s cause of death, only cardiovascular accident could be related to GD in BK treated with DMEK (p = 0.04). Conclusions: Our study shows that the conventional match between pathology and corneal lenticule is not sufficient to prevent ARB. Donor’s cause of death can impair graft and host attachment. In particular, cardiovascular death may impair the efficiency of donors’ endothelial cells, inducing GD after DMEK in BK.