descemet stripping endothelial keratoplasty (dsaek) following penetrating keratoplasty (pk)

Descemet Stripping Endothelial Keratoplasty (DSAEK)

Following Penetrating Keratoplasty (PK)

Amit Patel, FRCOphthMassimo Busin, MD

Villa Serena Hospital, Forli’, ItalyFondazione Banca degli Occhi del Veneto, Venice, Italy

------------------------------------------------------------------------------------------------------------Financial Disclosure

Pfizer (UK) Ophthalmic Fellowship Award (AP)Travel reimbursements and royalties from Moria, Antony, France (MB)

PURPOSE

• To Evaluate the Outcomes of DSAEK in Eyes With Post-Penetrating Keratoplasty (PK) Endothelial Decompensation.

METHODS

• Prospective Study– January 2007 to June 2009

• Cause of Endothelial Failure

• UCVA, BCVA, ECC noted at 1, 3, 6, 12 and 24 months post-DSAEK

• Complications

SURGICAL TECHNIQUE

• Descemetorhexis Within PK wound and Peripheral Iridotomy

• Graft Delivery with Busin Glide Through a 3.2mm Clear-Corneal Tunnel

SURGICAL TECHNIQUE

• 8.5 to 9.0mm Donor Button(arrows) Centered on the Limbus Regardless of the PK Wound

• Air Fill to Achieve Graft Attachment & Air-tight Suturing of All Wounds

RESULTS• 31 Cases Recruited• 29/31 Immunologic Graft

Failure• All DSAEK Grafts Larger

than Original PK(8.5-9.0 mm vs 7.5-8.0 mm)

RESULTS

• All Grafts Attached (1 case Required Re-bubbling)

• Average Follow up 9.8 Months (Range 3-24 Months)

• ECL at 1 year = 27.5% [16/31 eyes]

• No Graft Failures at Last Follow up

RESULTS

• Visual Outcomes– Pre-op BCVA <20/200 in

30/31 cases– Post-op BCVA

• Improved in 25/31 cases• Unchanged in 6/31 cases

RESULTS

• Complications– 1 Graft Detachment on 1st

Postoperative Day (Successful Attachment with Re-bubbling)

– 1 PK Wound Dehiscence (sutured )

– 1 Immunologic Graft Rejection (Treated Successfully)

CONCLUSIONS• DSAEK is Effective in Treating Post PK

Endothelial Failure• 2-Year Success Rate is High in Eyes with High

Risk of Rejection in spite of a Diameter Larger than that of the Original PK