Late detachment of donor graft after Descemet stripping automated endothelial keratoplasty

We describe the case of an 85-year-old man with pseudophakic bullous keratopathy. Descemet stripping automated endothelial keratoplasty (DSAEK) was performed, and 6 weeks postoperatively, subtle separation of the 2 corneal layers was noted. To our knowledge, this case of post-DSAEK graft detachment involves the longest interval between surgery and successful reattachment. It provides new insight into the survival of detached grafts following DSAEK, as well as a possible treatment for this complication.     

Graft detachment and rebubbling rate in Descemet membrane endothelial keratoplasty

Descemet membrane endothelial keratoplasty (DMEK) is a selective replacement of dysfunctional endothelium with healthy donor Descemet membrane and endothelium. Although the donor preparation and surgical methods still remain a challenge, DMEK is gaining popularity in terms of early rehabilitation and visual outcomes. New and improved donor preparation techniques like prestripped DMEK tissues are being taken up rapidly because of less manipulation that is required in the surgical theatre. Donor graft delivery in the recipient eye has also been improved because of new products like prestripped and preloaded membranes. As DMEK is at its budding stage, only early outcomes have been known so far. Early graft detachment, rebubbling rates, and primary failures are still being studied in DMEK. As there are different techniques that are currently used for preparation and injection of the graft, it becomes difficult to judge the results based on specific inclusion and exclusion criteria. Graft detachment and rebubbling rates have been a huge challenge both during the surgery and also while reporting postoperative data. We highlight the importance of defining graft detachment and rebubbling rates and their surgical relevance, which may also have an impact on graft preparation and insertion techniques.     

Cataract surgery after Descemet stripping endothelial keratoplasty

Management of endothelial dysfunction in phakic patients is sometimes a dilemma for corneal surgeons. Phakic patients with visually significant cataract and endothelial dysfunction are preferably managed by performing combined cataract surgery with endothelial keratoplasty. However, combined surgery may be deferred in eyes with early incipient cataract, younger age and where anterior chamber is poorly visualized. As cataract formation may be accelerated after endothelial keratoplasty, these eyes may need cataract surgery subsequently. Surgical intervention in eyes with endothelial keratoplasty is of concern as this may affect the graft adversely and threaten graft survival. In this report, we describe the intraoperative surgical details and postoperative clinical course of a patient who underwent phacoemulsification with intraocular lens implantation after Descemet stripping automated endothelial keratoplasty (DSAEK).     

Reorientation of inverted endothelial graft during Descemet stripping automated endothelial keratoplasty

We describe a technique during Descemet stripping automated endothelial keratoplasty for reorientation of an inverted endothelial graft. This technique allows the inversion to be predictably corrected with minimal manipulation and trauma to the endothelium, thereby reducing the risk of primary failure and subsequent repeat of the transplant.     

Femtosecond laser semi-assisted Descemet stripping endothelial keratoplasty: 2-year outcomes of endothelial cell loss and graft survival

Graefe's Archive for Clinical and Experimental Ophthalmology - To assess 2-year endothelial cell loss and graft survival after femtosecond laser semi-assisted Descemet stripping endothelial...     

Corneal profile analysis after Descemet stripping endothelial keratoplasty and its relationship to postoperative hyperopic shift

PURPOSE: To evaluate changes in the corneal profile after Descemet stripping endothelial keratoplasty (DSEK) using anterior segment optical coherence tomography (AS-OCT) analysis and to describe its relationship to a dynamic postoperative hyperopic shift. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, USA. METHODS: In this retrospective observational study, 9 eyes had DSEK and were followed with manifest refractions and AS-OCT analysis. To assess changes in the thickness of the cornea, measurements for each AS-OCT image were taken at the vertex of the cornea, at 1.5 mm on each side of the vertex, and at the distal edges of the graft. RESULTS: Patients were followed for a mean of 134 days (range 46 to 228 days). Monthly Graft thinning rates were 5.2 microm per month at the vertex, 7.9 microm per month 1.5 mm from the vertex, and 26 microm per month at the edges, with the edges thinning significantly faster than the cornea vertex (P = .0024) and the points on either side of the 3.0 mm visual axis (P = .0018). The mean spherical equivalent (SE) showed an initial hyperopic shift that decreased over the ensuing 100 to 200 days postoperatively. The mean monthly postoperative SE change was -0.25 diopter (D) with a mean preoperative to postoperative SE change of +1.26 D. CONCLUSIONS: The donor graft underwent changes after DSEK, which may account for the induced hyperopia and its diminishment over time via changes in the posterior corneal curvature. Results suggest that intraocular lenses be targeted to -1.00 to -1.25 D of myopia for combined DSEK and cataract procedures.     

Retrospective contralateral study comparing Descemet membrane endothelial keratoplasty with Descemet stripping automated endothelial keratoplasty

Purpose

In this retrospective study, the visual outcomes and postoperative complications after Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) in the fellow eye were compared. The patient''s satisfaction was evaluated.

Methods

A retrospective analysis of 10 patients, who underwent DSAEK in one eye and DMEK surgery in their fellow eye, was performed. Intraoperative and postoperative complications were recorded. Visual and refractive outcomes were evaluated, including higher-order aberrations (HOA) and contrast thresholds. A subjective questionnaire was used to evaluate patient satisfaction.

Results

Best-corrected visual acuity (BCVA) was significantly better in DMEK when compared with DSAEK (0.16±0.10 vs 0.45±0.58 logMAR, P=0.043). Contrast threshold was significantly higher after DMEK than after DSAEK (0.49±0.23 vs 0.25±0.18, P=0.043). Post-keratoplasty astigmatism, mean spherical equivalent, and HOA did not differ. Nine out of ten patients preferred the DMEK procedure. Visual outcome (4.80±1.14 vs 4.50±1.58, P=0.257), surgery associated pain and burden (DMEK: 1.30±0.48 vs DSAEK: 1.30±0.48, P=1.0), estimated time for recovery and rehabilitation (27.6±54.0 vs 24.9±54.8 days, P=0.173), and mean patient satisfaction (5.40±0.84 vs 5.00±1.05, P=0.257) were evaluated equally.

Conclusion

Patient satisfaction reached high, equal values after DMEK and after DSAEK. Nevertheless, patients preferred DMEK, if given a choice. Reasons for the preference may include better uncorrected and BCVA, and especially a better contrast sensitivity.     

Descemet stripping automated endothelial keratoplasty for microcornea

Purpose  

Our aim was to evaluate the surgical technique and postoperative results of Descemet stripping automated endothelial keratoplasty (DSAEK) for bullous keratopathy in eyes with microcornea.     

Long-term follow-up of deep anterior lamellar keratoplasty after Descemet stripping automated endothelial keratoplasty

Graefe's Archive for Clinical and Experimental Ophthalmology - To describe the long-term outcomes of deep anterior lamellar keratoplasty (DALK) performed after Descemet stripping automated...     

Suture technique for Descemet stripping and endothelial keratoplasty

PURPOSE: To describe a suture technique for Descemet stripping and endothelial keratoplasty (DSEK). METHODS: The technique was performed in 2 eyes of 2 patients with Fuchs endothelial corneal dystrophy. A double-armed 10-0 prolene suture on a CIF-4 needle was used to pull the donor corneal button into the recipient's anterior chamber without the use of forceps to hold the button. The suture was also used to unfold the lenticule in the eye without marking the stroma with gentian violet, to center the lenticule and to secure that in place. RESULTS: No intraoperative problems occurred in either case. The suture technique was successfully used to pull the donor button into the host's eye and to unfold and center the button. Both lenticules were well centered and had minimal corneal edema. At 6 months, the central endothelial loss was 8% in the first case and 10% in the second. CONCLUSION: This suture technique for DSEK avoids the use of forceps and allows less traumatic donor button manipulation. It may be an effective alternative with low endothelial damage; further follow-up will determine the long-term effect on the central endothelial cell count.