Clinical Outcomes of Two Lenticule Thickness Types in Descemet Stripping Automated Endothelial Keratoplasty: One-Year Results

To compare clinical outcomes of eyes undergoing Descemet stripping automated endothelial keratoplasty (DSAEK) with 51-99 μm and &lt;50 μm lenticules. Retrospective, multi-center case series of 480 eyes undergoing DSAEK with precut tissue from a single eye bank between 2019 and 2022 performed by five surgeons at five centers. Eyes were divided into 51-99 μm or &lt;50 μm groups according to post-cut graft thickness. The main outcome measure was inter-group comparison according to best-corrected distance visual acuity (BCDVA); additional outcome measures were primary graft failure (PGF), rebubbling, and cystoid macular edema (CME) rates in context of specific preoperative risk factors, intraoperative characteristics, and vision-limiting vs. non-vision-limiting morbidities. BCDVA at one year postoperatively was 0.5 ± 0.5 and 0.4 ± 0.4 logMAR for the 51-99 μm and &lt;50 μm groups, respectively (<i>p</i> = 0.692). Regraft rate was 3.21% for 51-99 μm and 1.89% for &lt;50 μm grafts (<i>p</i> = 0.4854). Rebubbling rate was 8.56% for the 51-99 μm group and 13.21% for the &lt;50 μm group (<i>p</i> = 0.151). Analysis of rebubbled eyes showed no difference in rate of sulfur hexafluoride tamponade (<i>p</i> = 0.201), lenticule insertion method (<i>p</i> = 0.293), and glaucoma surgery history (<i>p</i> = 0.996). Higher rebubbling rates occurred in eyes with previous scleral-fixated intraocular lenses (<i>p</i> &lt; 0.001). The effect of potential preoperative and intraoperative risk factors (e.g. insertion method (<i>p</i> = 0.979) and concurrent cataract surgery (<i>p</i> = 0.701)) on rebubbling was not significantly different between the two groups. CME rate was 4.01% for 51-99 μm and 7.54% for &lt;50 μm groups (<i>p</i> = 0.131). 51-99 μm and &lt;50 μm DSAEK grafts offer similar visual outcomes. Both lenticule thicknesses have similar regrafting, rebubbling, and CME rates.