Descemet's Stripping Endothelial Keratoplasty: Safety and Outcomes (original) (raw)
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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.
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.
Outcomes of Descemet stripping endothelial keratoplasty in cases of corneal endothelial dysfunction
PubMed, 2023
Background: Automated microkeratome is commonly used to get donor lenticules for Descemet stripping endothelial keratoplasty (DSEK); however, manual dissection of donor lenticules is also being done with good outcomes. Aim: The aim of this study was to describe the results of manual DSEK performed in cases of corneal endothelial dysfunction caused due to pseudophakic bullous keratopathy, iridocorneal endothelial syndrome, and postpenetrating keratoplasty graft failure. Materials and methods: This was a retrospective observational study. The medical records of all patients with corneal decompensation who underwent DSEK at a tertiary care center performed by the same surgeon were reviewed. A standard DSEK with manually dissected donor lenticules was performed in all cases with the exception of the Descemet membrane not being removed in two cases. A comprehensive ophthalmic examination was performed preoperatively and at each postoperative visit in all patients. Results: Eight eyes of seven patients (four males and three females) were included. The mean age was 64.8 years (range, 49-74 years). The average follow-up was 10.9 months (range, 5-22 months). There was one case of primary graft failure which was managed by repeat DSEK. In the rest, corneas remained clear at the last follow-up. No rebubbling was done as none of the cases showed graft detachment. The preoperative best-corrected visual acuity (BCVA) was 20/2000 or less, and postoperatively, BCVA attained was 20/30 in four eyes and one eye achieved 20/80. Conclusions: Manual DSEK performed in eyes with corneal decompensation allowed rapid restoration of corneal clarity while minimizing intraoperative and postoperative complications.
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.
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.
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.
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.
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...
Journal of Cataract & Refractive Surgery, 2008
Background: To report a patient with penetrating keratoplasty (PKP) graft endothelial failure implanted with toric intraocular lens (IOL) who was treated with Descemet stripping endothelial keratoplasty (DSAEK). Case presentation: A 40 year old male patient implanted with toric intraocular lens for the treatment of post PKP astigmatism, presented for the treatment of graft endothelial failure'. The patient had uncorrected distance visual acuity (UDVA) 20/200 not correcting with manifest refraction. The patient reported excellent visual acuity after cataract surgery and toric IOL implantation. DSAEK was performed in order to minimally affect keratometry and retain correspondence of the anterior cornea astigmatism with the toric IOL astigmatic power. Three months postoperatively the cornea was clear with no edema. UDVA was 20/40 and corrected distance visual acuity was 20/25 with +1.50-1.00 × 20.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2018
Aims To describe the long-term outcomes of deep anterior lamellar keratoplasty (DALK) performed after Descemet stripping automated endothelial keratoplasty (DSAEK) in cases of infection and residual stromal opacity. Methods Ten eyes of nine consecutive patients undergoing DALK after DSAEK at a single tertiary referral center (SNEC) from 2011 to 2016 were analyzed for best spectacle-corrected visual acuity (BSCVA), refraction, spherical equivalent (SE) and cylinder, as well as graft diameters, survival, and complications. Results The mean pre-DSAEK BSCVA was 1.73 ± 0.76 LogMAR. At a mean follow-up of 9.8 ± 7.1 months, visual acuity had improved significantly (p = 0.028) to 1.09 ± 0.55 LogMAR after DSAEK. DALK was performed at 10.3 ± 7.2 months after DSAEK because of residual stromal scarring in nine and a corneal infection in one case. At the last follow-up visit (19.4 ± 13.9 months) after DALK, BSCVA had improved to 0.38 ± 0.6 LogMAR, significantly better than after DSAEK alone (p = 0.015) and before DSAEK (p = 0.018). Spherical equivalent (− 4.8 ± 3.5 D) and cylinder (− 2.5 ± 2.0 D) did not show significant changes compared to after DSAEK (SE p = 0.17; cylinder p = 0.19) or 3 months after DALK (SE p = 0.17; cylinder p = 0.46). One endothelial graft failed 3 months after DALK. Kaplan-Meier estimated average survival for all cases was 45.3 (95% CI 36.6-54.0) months. The cumulative survival probability for the entire cohort was 90% at 1, 2, and 4 years of follow-up. Conclusions DALK surgery after DSAEK can improve vision in cases of residual host scarring and treat host corneal infection, while avoiding open-sky surgery and sparing a healthy endothelial graft.