Effect of venting incisions on graft attachment in Descemet's stripping automated endothelial keratoplasty

PURPOSE: To investigate the impact of venting incisions on the adherence of graft to the recipient's stroma in Descemet's stripping automated endothelial keratoplasty (DSAEK). METHODS: Fifty-six patients were enrolled in this study. Patients were randomly allocated into two groups. Twenty-eight patients had a DSAEK procedure with venting incisions. The second group was treated by conventional DSAEK with no venting incisions. Slit-lamp examination and anterior segment optical coherence tomography (AS-OCT) were performed in day one and 14 days after surgery to investigate graft attachment. The thickness of cornea and lenticle were also evaluated by AS-OCT. BCVA (logMAR) was measured the day before the surgery and 14 days postoperatively. RESULTS: Subclinical graft detachment in the first day after surgery was significantly lower in patients who had a DSAEK procedure and venting incisions (P = 0.02), but no difference was noted in the rate of clinical graft detachment on day one (P = 0.24) and subclinical and clinical graft detachment on day 14 (P = 0.24, P = 0.50, respectively). The thickness of the cornea and lenticle after the surgery were statistically similar between the two groups (P = 0.903, P = 0.402, respectively). No difference in the improvement of BCVA was observed between the venting and non-venting group (P = 0.143). CONCLUSIONS: Routine use of venting incisions may not be necessary in the standard DSAEK procedures. More studies with larger sample sizes are needed to better confirm the results of this study.