Descemet's Stripping Endothelial Keratoplasty: Safety and Outcomes (original) (raw)
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.
Descemet Membrane Endothelial Keratoplasty: Safety and Outcomes
Ophthalmology, 2017
Purpose: To review the published literature on the safety and outcomes of Descemet membrane endothelial keratoplasty (DMEK) for the surgical treatment of corneal endothelial dysfunction. Methods: Literature searches were last conducted in the PubMed and the Cochrane Library databases most recently in May 2017. The searches, which were limited to English-language abstracts, yielded 1085 articles. The panel reviewed the abstracts, and 47 were determined to be relevant to this assessment. Results: After DMEK surgery, the mean best-corrected visual acuity (BCVA) ranged from 20/21 to 20/31, with follow-up ranging from 5.7 to 68 months. At 6 months, 37.6% to 85% of eyes achieved BCVA of 20/25 or better and 17% to 67% achieved BCVA of 20/20 or better. Mean endothelial cell (EC) loss was 33% (range, 25%e47%) at 6 months. Overall change in spherical equivalent was þ0.43 diopters (D; range, e1.17 to þ1.2 D), with minimal induced astigmatism of þ0.03 D (range, e0.03 to þ1.11 D). The most common complication was partial graft detachment requiring air injection (mean, 28.8%; range, 0.2%e76%). Intraocular pressure elevation was the second most common complication (range, 0%e22%) after DMEK, followed by primary graft failure (mean, 1.7%; range, 0%e12.5%), secondary graft failure (mean, 2.2%; range, 0%e6.3%), and immune rejection (mean, 1.9%; range, 0%e5.9%). Overall graft survival rates after DMEK ranged from 92% to 100% at last follow-up. Best-corrected visual acuity after Descemet's stripping endothelial keratoplasty (DSEK) ranged from 20/34 to 20/66 at 9 months. The most common complications after DSEK were graft detachment (mean, 14%; range, 0%e82%), endothelial rejection (mean, 10%; range, 0%e45%), and primary graft failure (mean, 5%; range, 0%e29%). Mean EC loss after DSEK was 37% at 6 months. Conclusions: The evidence reviewed supports DMEK as a safe and effective treatment for endothelial failure. With respect to visual recovery time, visual outcomes, and rejection rates, DMEK seems to be superior to DSEK and to induce less refractive error with similar surgical risks and EC loss compared with DSEK. The rate of air injection and repeat keratoplasty were similar in DMEK and DSEK after the learning curve for DMEK.
Descemet's stripping automated endothelial keratoplasty: avoiding complications
Elsevier eBooks, 2009
Taken together, causes of endothelial decompensation represent a major indication for corneal transplantation. Posterior lamellar grafts allow patients with endothelial failure to avoid many of the complications associated with the full thickness penetrating keratoplasty. Evolving over the last decade, Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) represents the latest incarnation of posterior lamellar grafting techniques. This article contains four case reports from the cornea clinic where the author is a resident, and a review of literature highlighting the benefits of posterior lamellar grafting.
Ophthalmology, 2013
Purpose-To assess 3-year outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in comparison with penetrating keratoplasty (PKP) from the Cornea Donor Study (CDS). Design-Prospective, multicenter, nonrandomized clinical trial. Participants-A total of 173 subjects undergoing DSAEK for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic corneal edema) compared with 1101 subjects undergoing PKP from the CDS. Methods-The DSAEK procedures were performed by two experienced surgeons using the same donor and similar recipient criteria as for the CDS PKP procedures, performed by 68 surgeons. Graft success was assessed by Kaplan Meier survival analysis. Central endothelial cell density (ECD) was determined from baseline donor and postoperative central endothelial images by the reading center used in the CDS Specular Microscopy Ancillary Study. Main Outcome Measures-Graft clarity and endothelial cell density
Descemetʼs stripping with automated endothelial keratoplasty and glaucoma
Current Opinion in Ophthalmology, 2010
Purpose of review Descemet's stripping with automated endothelial keratoplasty (DSAEK) has recently become the preferred surgical procedure replacing penetrating keratoplasty (PKP) for corneal endothelial disorders. However, DSAEK may also be associated with postprocedure intraocular pressure elevation and secondary glaucoma, and presents unique surgical challenges in patients with preexisting glaucoma surgeries. Recent findings The relatively high rate of glaucoma induction or worsening after PKP has significant implications leading to corneal graft failure and irreversible vision loss from glaucomatous optic neuropathy. In contrast, DSAEK, in addition to providing excellent visual outcomes with faster recovery, may provide advantages over PKP with lower risk of serious, vision-threatening glaucoma-related complications. Pupillary block glaucoma, steroid-induced intraocular pressure elevation, and less commonly peripheral anterior synechiae development have been reported after DSAEK. In patients with preexisting glaucoma surgical procedures (trabeculectomy or tube shunts), special attention to techniques (which continue to evolve) are required to perform DSAEK safely and effectively. Summary As DSAEK continues to gain popularity and advance with more studies performed, our understanding of DSAEK-associated intraocular pressure elevation and secondary glaucoma-related complications will become more complete. Current limited data suggest that DSAEK may be a suitable surgical alternative to PKP in patients with corneal endothelial disease and coexistent glaucoma with or without prior glaucoma procedures with faster recovery and good visual outcomes.
Cornea, 2018
Endothelial keratoplasty (EK) describes a group of surgical procedures for managing corneal endothelial dysfunction. The most common is Descemet's stripping endothelial keratoplasty (DSEK). The procedure may be repeated in the event of a failed DSEK from several causes. There have been several reports examining various combinations of repeat keratoplasty techniques for failed grafts (full and partialthickness). Since the number of repeat DSEK cases is typically low at any single center, our aim was to collaborate with the Eversight Eye Bank to establish a multicenter study to evaluate a large number of repeat DSEK cases. The goal of our study is to report the risk factors and outcomes of the repeat DSEK procedures from multiple sites/surgeons to provide a more realistic assessment of the results. Methods: We performed an IRB-approved, multicenter, retrospective chart review of patients who had a repeat DSEK following a prior failed DSEK. Eversight Eye Bank provided detailed donor information including age, sex, pre-and post-cut corneal thickness, endothelial cell densities, graft thickness and death to preservation time. Five different Midwest academic centers and two private practice centers participated in the study. Information extracted from the participant charts included: recipient demographics, pre-op and post-op visual acuities, initial and repeat DSEK indications, central corneal thickness, number of glaucoma drops pre-and postrepeat DSEK, post-op endothelial cell counts, central corneal thickness and comorbid ocular and systemic diseases. Results: A total of 120 eyes from 120 patients who underwent repeat DSEK were identified among the study sites. The average age was 70 ± 12 years with a female-to-4 male ratio of 1.45:1. The average time from initial to repeat DSEK for all patients was approximately 1.9 years and significantly differed per indication. The most common indication for initial DSEK was Fuch's endothelial dystrophy (31%, N=38). The most common indication for repeat DSEK was late endothelial graft failure without rejection (52%, N=63). Average pre-and 12 month post-repeat DSEK best corrected distance visual acuities (BCDVA) were 20/693 and 20/89, respectively. The mean repeat donor graft thickness was 153 ± 43 microns. The mean initial and repeat donor endothelial cell counts were 2767 ± 264 cells/mm 2 and 2744 ± 272 cells/mm 2 , respectively. Initial and repeat graft re-bubble rates were 34% (N = 40) and 15% (N = 18). The presence of glaucoma, prior glaucoma surgery or a history of PKP did not significantly affect the visual outcomes; however, there was a trend towards better visual outcomes in patients with an absence of glaucoma, anti-hypertensive eye drops and glaucoma surgery. Patients with higher pre-operative intraocular pressures prior to repeat DSEK had statistically significant improvements in postoperative visual acuities. Conclusion: Our report represents the largest multi-center study describing risk factors, indications and outcomes of repeat DSEK surgery. Repeating DSEK provides a good option for improving vision following failed or decompensated initial DSEK surgery. The results of the study may provide valuable information for surgeons considering a repeat DSEK procedure.
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...