Descemet-stripping endothelial keratoplasty: improvement in vision following replacement of a healthy endothelial graft (original) (raw)
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American Journal of Ophthalmology, 2010
PURPOSE: To evaluate complications and clinical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with intraocular lens (IOL) exchange compared with DSAEK alone. • DESIGN: Retrospective, interventional case series. • METHODS: DSAEK was performed in 19 eyes in which the anterior chamber IOL was exchanged for a posterior chamber IOL (study group) and in 188 eyes in which the posterior chamber IOL was left in place (comparison group). The complications of graft dislocations, primary graft failure episodes, and pupillary block were recorded for all eyes. Six-month best spectacle-corrected visual acuity and mean central endothelial cell density were measured prospectively and then compared with preoperative values for all eyes. • RESULTS: Dislocations occurred in 0 (0%) of 19 eyes in the study group and in 5 (3%) of 188 eyes in the comparison group (P ؍ .47), with 0 primary graft failures and 0 pupillary block episodes in either group.
Descemet's stripping with endothelial keratoplasty in 200 eyes
Journal of Cataract & Refractive Surgery, 2006
To evaluate early visual and refractive outcomes following treatment of corneal endothelial dysfunction with a corneal transplantation technique, Descemet's stripping with endothelial keratoplasty (DSEK). Visual and refractive outcomes of the first 50 consecutive cases of DSEK performed by a single surgeon between December 2003 and July 2004 were analyzed retrospectively. The DSEK technique consisted of stripping Descemet's membrane and endothelium from a recipient cornea and transplanting the posterior stroma and endothelium of a donor cornea through a 5-mm incision. Results are reported for 50 eyes in 47 patients (30 women and 17 men). Mean patient age at surgery was 70 +/- 12 years (range: 34 to 89 years). Five eyes were treated for corneal edema or bullous keratopathy and 45 for Fuchs' endothelial dystrophy. Seven eyes were phakic and 43 were pseudophakic. Six months after surgery, mean manifest cylinder was 1.5 +/- 0.94 diopters (D), unchanged from preoperative cylinder of 1.5 +/- 1.0 D. Mean manifest spherical equivalent refraction was 0.15 +/- 1.5 D at 6-month follow-up compared with -0.36 +/- 1.4 D preoperatively (P = .10) At 3- and 6-month follow-up, significant improvement was noted in mean best spectacle-corrected visual acuity compared with the preoperative mean of 20/100 (P = .007). At 6-month follow-up, 31 (62%) eyes refracted to > or = 20/40 and 38 (76%) eyes saw > or = 20/50. Compared to standard penetrating keratoplasty, DSEK causes minimal refractive change and provides rapid visual recovery for patients with endothelial dysfunction. This technique maintains the structural integrity of the cornea by preserving the recipient's epithelium, Bowman's layer, and entire stromal thickness.
JAMA ophthalmology, 2014
Descemet stripping automated endothelial keratoplasty (DSAEK) for isolated endothelial dysfunction has become the preferred surgical option for many corneal surgeons. However, there are limited large-scale reports on DSAEK survival and clinical variables affecting the risk of rejection and failure after failed penetrating keratoplasty (PK). To report the survival, risk factors for graft rejection and failure, and visual outcome of DSAEK after failed PK. A multicenter retrospective interventional case series included patients recruited from 6 tertiary referral surgical centers: 3 in the United States, 2 in Europe, and 1 in Asia. A total of 246 consecutive eyes (246 patients) that underwent DSAEK after failed PK, with a minimum follow-up period of 1 month, was included. Data comprising demographic details, preoperative and postoperative risk factors, time to rejection, time to failure, and corrected distance visual acuity were collected. Cumulative probability of graft survival, hazar...
Cornea, 2007
To report our clinical experience and 12-month results of small-incision Descemet-stripping endothelial keratoplasty (DSEK). Methods: Prospective study of 11 eyes of 9 patients who had DSEK. The DSEK technique consisted of stripping the Descemet membrane and endothelium from the recipient cornea. The donor button was prepared by manual dissection and inserted through a 5-mm incision. Air, sulfur hexafluoride (SF 6), or perfluoropropane (C 3 F 8) was used both at the end of surgery and in subsequent dislocations to promote donor tissue adherence. Results: Mean age was 79.6 years (range, 66-91 years), and minimum follow-up was 12 months (range, 12-18 months). Nine eyes had donor tissue dislocation postoperatively, 8 of which received intervention with either SF 6 (n = 4) or C 3 F 8 (n = 4). In 1 patient with repeat dislocation, Tisseel glue in combination with C 3 F 8 was used. Preoperative best-corrected visual acuity (BCVA) was 6/24 or worse in all patients. Postoperatively, 6/11 eyes (55%) achieved a BCVA of 6/12 at last follow-up. Mean preoperative cylinder was 1.875 6 0.906 D (range, 1-3 D) and postoperatively was 1.5 6 1.157 D (range, 0.25-3.25 D). At last follow-up, 6 grafts were clear and 5 had failed. Mean endothelial cell count in the clear grafts at 12-month follow-up was 1078 6 507 cells/mm 2. Conclusions: DSEK provided excellent refractive and reasonable visual outcomes in our limited series, but there were frequent problems with dislocation of the donor tissue, and the graft failure rate was high. The graft failures may be linked to excessive endothelial damage, and the high dislocation rate may be linked to not filling the anterior chamber totally with air after insertion of the donor. Further development of the procedure is necessary.
American Journal of Ophthalmology, 2009
were reviewed. A total of 126 eyes of 113 patients underwent DSAEK. All cases were included regardless of outcome. All complications intraoperatively and postoperatively were recorded. • RESULTS: Graft detachment was the most common complication, occurring in 22 eyes (17.5%); 17 of these (77%) were successfully repositioned. Idiopathic graft failure occurred in 15 eyes (6%). Other visually significant complications included graft rejection (2 eyes), choroidal effusion (2 eyes), epithelial ingrowth (2 eyes), endophthalmitis (1 eye), pupillary block (1 eye), and suture abscess (1 eye). Twenty-four eyes had nonvisually significant complications including decentered lenticles, interface fibers, partial peripheral detachments, retained Descemet membrane, and eccentric trephination. • CONCLUSIONS: While DSAEK is a viable alternative to penetrating keratoplasty, serious complications may still occur postoperatively. While certain rare complications like endophthalmitis, epithelial ingrowth, and suture abscess may affect vision, more common complications such as decentered lenticles and partial peripheral detachments are less likely to affect visual outcome. (Am J Ophthalmol 2009;148:837-843.
Cornea, 2008
Background: To evaluate the in vivo corneal changes using in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in patients with Fuchs' dystrophy who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) and the relationship between these changes and the postoperative visual recovery up to 1-year follow-up. Methods: Before DSAEK and 1 day, 3, 6 and 12 months after surgery 31 patients (39 pseudophakic eyes) underwent a complete ophthalmological evaluation including best corrected visual acuity (BCVA), IVCM (subepithelial haze, interface haze, graft thickness) and AS-OCT (graft thickness). Results: Graft thickness measurements by AS-OCT were strongly correlated to those obtained using IVCM at every follow-up stage (intraclass correlation coefficient = 0.95 to 0.97 between 3 and 12 months, P < 0.001 for all coefficients). No correlation between BCVA and graft thickness measured by AS-OCT at any follow-up stage was found, while at 3 and 6 postoperative months the correlations between BCVA and preoperative subepithelial haze (r = 0.61, P < 0.001 and r = 0.46, P = 0.002), interface haze (r = 0.51, P < 0.001 and r = 0.46, P = 0.003), postoperative subepithelial haze (r = 0.43, P = 0.004 and r = 0.39, P = 0.001) were significant. Conclusions: The study confirmed corneal subepithelial haze and interface haze as important factors limiting visual acuity after DSAEK, while graft thickness was not related to BCVA.