Correlation between visual acuity and interface reflectivity measured by pentacam following DSAEK

Purpose: Descemet‐stripping automated endothelial keratoplasty (DSAEK) is an advanced method of lamellar endothelial keratoplasty. In comparison with penetrating keratoplasty, visual rehabilitation seems to be faster. Final visual outcome of DSAEK, however, seems to be limited, especially in comparison with Descemet membrane endothelial keratoplasty (DMEK). DSAEK cases without graft failure often do not show any definite correlate for the reduced optical performance. In this study, we tried to correlate visual acuity following DSAEK with interface reflectivity as measured by a rotating Scheimpflug system. Methods: We examined 14 eyes of 13 patients with the pentacam for 2–11 months following DSAEK. Reflectivity of the interface region in the centre of the optical axis as well as central corneal thickness was determined. Statistical correlation between interface reflectivity and best spectacle‐corrected visual acuity, central corneal thickness and follow‐up time was drawn (multifactorial linear regression analysis). Results: Statistically significant correlation between interface reflectivity and BSCVA as well as follow‐up time was found. Reflectivity was highest in regions of interface (metal) particles. There was no statistically significant correlation between interface reflectivity and central corneal thickness. Conclusion: We present a measurable correlate for reduced visual outcome following DSAEK despite a clear graft. Inverse correlation between interface reflectivity and best spectacle‐corrected visual acuity (BSCVA) indicates that irregularities or scarring in the interface region may influence the optical quality following DSAEK.     

Outcomes of Descemet’s stripping endothelial keratoplasty in eyes with failed therapeutic penetrating keratoplasty

Purpose: To report the results of Descemet’s stripping endothelial keratoplasty (DSEK) for failed therapeutic penetrating keratoplasty (PK). Methods: Twenty‐seven eyes of 27 patients undergoing DSEK for failed therapeutic PK were analysed. Results: The mean age of the patients was 36 ± 13.9 years (range: 14–70 years). The median size of the therapeutic graft was 10 mm (inter‐quartile range; IQR 9.5–11 mm). Descemet’s membrane stripping was performed in all eyes. Graft clarity was achieved in 20/27 eyes. Six eyes had primary graft failure, and one had interface keratitis in the early postoperative period. In all eyes with primary graft failure, there was progressive stromal vascularization, which led to haziness in the graft. Late postoperative complications were rejection in four eyes, infection in two eyes, secondary graft failure in one eye and vortex keratopathy in one eye. Graft size was found to be a significant risk factor for graft rejection in this series. At the last follow‐up visit, the best‐corrected visual acuity was ≥20/40 in 5/27 eyes (18.5%), 20/60–20/40 in 12/27 eyes (44.4%), 20/100–20/60 in 3/27 eyes (1.5%) and ≤20/200 in 7/27 eyes (25.9%). Conclusions: Considering the limited success of repeat PK in failed large therapeutic keratoplasty, DSEK is a viable option for visual rehabilitation in these eyes, however; visual acuity may be limited due to sub‐epithelial/stromal or interface scarring.     

简化DSEK技术在复杂性大泡性角膜病变中的应用

目的观察简化的后弹力层撕除角膜内皮移植术(Descemet’s stripping endothelial keratoplasty,DSEK)治疗复杂性大泡性角膜病变的疗效。设计回顾性病例系列。研究对象2015年12月至2017年8月北部战区总医院接受手术治疗的11例(11眼)复杂性大泡性角膜病变患者。方法所有患者接受了DSEK,术中所有供体植片采用手工剖切制作,平均直径(8.05±0.57)mm,植片均采用滑板法植入。主要指标术后早期植片贴附情况及并发症;随访1年时最佳矫正视力(BCVA)、角膜散光、植片透明度和厚度、内皮细胞密度和手术并发症。结果11眼中8眼术后植片与植床贴附良好;3眼术后植片半脱位,经再次前房注气后植片贴附良好。1眼术后4个月继发开角型青光眼。术后1年BCVA 7例患者≥0.3;平均角膜散光度数为(1.83±0.46)D;11眼植片均透明,平均植片厚度(126±19)μm;平均内皮细胞密度(954±218)个/mm2;11眼均无排斥反应发生。结论复杂性大泡性角膜病变行简化DSEK可获得满意的疗效。     

Two-year clinical outcome after Descemet membrane endothelial keratoplasty using a standardized protocol

Purpose:The purpose of this study is to evaluate 2-year clinical outcome after Descemet membrane endothelial keratoplasty (DMEK) in a variety of endothelial dysfunctions using a standardized protocol.Methods:From a group of 230 eyes which underwent DMEK for Fuchs'' endothelial corneal dystrophy (FECD), aphakic and pseudophakic bullous keratopathy, failed full thickness corneal transplants, ICE syndrome, failed DSEK, and TASS the clinical outcomes [best spectacle-corrected visual acuity (BSCVA), central endothelial cell density (ECD)] were evaluated before, and at 6, 12, and 24 months and the success rate, failure rate and postoperative complications were also analyzed.Results:Out of 230 eyes, 144 eyes (70%) had BSCVA 6/9 or better 2 years postoperatively. Mean donor ECD was 2692.23 (range, 2300–3436) cells/mm² preoperatively, which was reduced to 1433.64 (range, 619.0–2272.0) cells/mm² 2 years after DMEK surgery, indicating a mean reduction of 1258 cells/mm² (46%) in ECD.Conclusion:DMEK is a highly successful surgical procedure when following a standard protocol for treating diseases of the corneal endothelium providing a near perfect anatomic restoration and a high degree of visual rehabilitation.     

自动板层刀辅助的后弹力层前膜角膜内皮移植术

角膜内皮移植已成为治疗角膜内皮病变的首选方法.作为目前主流的2种角膜内皮移植手术——后弹力层剥除自动板层刀制备的角膜内皮移植术和后弹力层角膜内皮移植术,前者手术操作易于掌握,但角膜植片仍带有部分基质;后者术后视觉质量好,但手术操作较难掌握,二次手术率较前者高.大气泡和自动板层刀辅助的后弹力层前膜角膜内皮移植术在自动板层刀制备角膜内皮植片的基础上,用大气泡法暴露中央6.5 mm直径的后弹力层前膜,本术式既有后弹力层角膜内皮移植术后的视觉效果,手术操作又易于掌握,值得推广.     

Descemet-stripping automated endothelial keratoplasty: a successful alternative to repeat penetrating keratoplasty

Background: Although Descemet‐stripping automated endothelial keratoplasty has replaced penetrating keratoplasty for primary treatment of endothelial disorders, many patients have already undergone penetrating keratoplasty. It is unclear when repeat penetrating keratoplasty is necessary or when endothelial keratoplasty may restore clarity to a failed graft. Design: Retrospective case series of patients undergoing Descemet‐stripping automated endothelial keratoplasty after penetrating keratoplasty by three surgeons at an academic tertiary care centre. Participants: Eight patients with Descemet‐stripping automated endothelial keratoplasty after penetrating keratoplasty from 2006 to 2009. Methods: Microkeratome‐prepared Descemet‐stripping automated endothelial keratoplasty donor tissue was used. In seven cases, the penetrating keratoplasty bed was neither stripped nor scraped, and in one, scraping only was performed. Main Outcome Measures: Preoperative and 6‐month postoperative best‐corrected visual acuities in logMAR (logarithm of the minimum angle of resolution). Results: The average pre‐Descemet‐stripping automated endothelial keratoplasty best‐corrected visual acuity was 1.375, and the average best‐corrected visual acuity 6 months postoperatively was logMAR 1.0, a 2.5‐fold improvement in the minimum angle of resolution (P = 0.22). Seven of the eight patients showed an improvement in best‐corrected visual acuity, and one patient had failure of Descemet‐stripping automated endothelial keratoplasty and required penetrating keratoplasty. Five had a postoperative event: one had a gap that resolved spontaneously, three required rebubblings (injections of air only without otherwise repositioning the graft), and one experienced graft failure. Conclusions: Descemet‐stripping automated endothelial keratoplasty can successfully rescue a prior penetrating keratoplasty, even with a fairly high detachment rate. Given these favourable visual outcomes, further study of this promising strategy is justified.     

A Comparison of Posterior Lamellar Keratoplasty Modalities: DLEK vs. DSEK

Purpose

To compare clinical outcomes after deep lamellar endothelial keratoplasty (DLEK) with Descemet stripping endothelial keratoplasty (DSEK) performed as initial cases by a single surgeon.

Methods

Sixteen patients with corneal endothelial were enrolled. Eight patients (8 eyes) underwent DLEK and 8 patients (8 eyes) DSEK. We measured uncorrected visual acuity, best corrected visual acuity (BCVA), manifest refraction, corneal endothelial count, interface opacity via Schiempflug imaging, and contrast sensitivity, as well as tracked postoperative complications over the first postoperative year.

Results

Primary graft failure occurred in two DLEK cases and one DSEK case, all of which were excluded for further analysis. The average 12-month postoperative BCVA was 20/70 in the DLEK group and 20/50 in the DSEK group, with the difference not statistically significant. No significant differences were identified between the 2 groups in terms of mean spherical equivalent and refractive astigmatism, although individuals in the DSEK group tended toward hyperopia. The average endothelial cell count at postoperative month 12 was 1849±494 in the DLEK group and 1643±417 cells/mm² in the DSEK group, representing cell losses of 26.2% and 31.9%, respectively. No significant differences in endothelial cell count or endothelial cell loss were observed between groups. Early postoperative donor disc dislocation occurred in two eyes after DLEK and one eye after DSEK. Interface opacities and contrast sensitivities were similarly not significantly different between groups.

Conclusions

No significant differences in any assessed clinical outcome were observed between individuals undergoing DLEK and DSEK, when performed as initial cases by a single surgeon.     

Queratoplastia penetrante temprana después de queratitis fúngica de la interface en la queratoplastia endotelial de la membrana de Descemet

In this case-report we describe the first reported case of early-onset fungal interface keratitis (IK) after Descemet Membrane Endothelial Keratoplasty (DMEK) successfully treated with penetrating keratoplasty (PK) during the active stage of infection. A patient with graft failure after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) was operated on with DMEK. Donor rim culture and broth were positive for Candida albicans. Several interface infiltrates were confirmed and localized using anterior segment optical coherence tomography. Three days after diagnosis, observing clear signs of intraocular infection, the graft was removed with simultaneous washed-up of anterior chamber with fluconazole 1% followed by a PK and intrastromal corneal injections of fluconazole. A best-corrected visual acuity of 20/20 was achieved. This case highlights the importance of analysing every donor rim and broth, despite the patient doesn’t show any symptoms or signs during the post-operative period. PK is a viable treatment option in early-onset interface keratitis.     

Clinical results of non-Descemet stripping endothelial keratoplasty

AIM: To investigate the impact of non-Descemet stripping endothelial keratoplasty (non-DSEK) on graft rejection rate, and its overall procedural effectiveness in patients. METHODS: Non-DSEK was performed on 65 eyes of 64 patients, and the procedural outcomes, including rejection episodes, failure and dislocation of the grafts, best corrected visual acuity (BCVA), endothelial cell density (ECD), and other complications, were analyzed retrospectively. RESULTS: Of the 65 eyes, 63 recovered from bullous keratopathy with a clear cornea. The mean follow-up time was 26.4mo (range, 6-84mo). The mean BCVA improved from 1.70 logMAR preoperatively to 0.54 logMAR at 3mo, 0.46 logMAR at 6mo, and 0.37 logMAR at 1y after surgery. The postoperative donor ECD of the 25 patients who successfully underwent specular microscopic examination was 1918±534 cells/mm2 (range, 637 to 3056 cells/mm2), and the mean endothelial cell loss was 41.9% at 24mo postoperatively. One eye developed secondary glaucoma and required regrafting via penetrating keratoplasty (PKP). Another eye had postoperative graft failure due to rejection at 26mo. Postoperative graft dislocation occurred in eight eyes. All of the eight dislocated grafts were reattached using air reinjection. CONCLUSION: Immunological graft rejection of the donor graft rarely occurs in non-DSEK. Therefore, non-DSEK is a safe, concise, and effective alternative to restore corneal decompensation when the Descemet membrane is disease-free.     

Therapie von Hornhautendothelerkrankungen mittels DMEK und UT-DSAEK

Various techniques for posterior lamellar keratoplasty have been established for the clinical routine and continuously improved during the last 15 years so that an extremely rapid recovery of vision is possible due to very thin transplants. Descemet membrane endothelial keratoplasty (DMEK) is the method of choice for simple corneal endothelial diseases and has already been applied in complex conditions of the anterior segment. The learning curve for DMEK is comparatively long and the risk of complications in complex anterior segment pathologies is higher than in Descemet’s stripping automated endothelial keratoplasty (DSAEK); however, DMEK results in better visual outcome and less graft rejections than DSAEK. The latest evolution in posterior lamellar transplant surgery is ultrathin DSAEK (UT-DSAEK), where the grafted lamella is much thinner than in conventional DSAEK. Currently available data suggest that the resulting visual acuity after UT-DSAEK is close to the visual acuity seen after DMEK; however, studies comparing the results after DMEK and UT-DSAEK are so far lacking. Whether the transplantation of these very thin DSAEK grafts also results in endothelial cell densities and graft rejection rates comparable to DMEK has to be proven.     

Descemet stripping and endothelial keratoplasty in endothelial dysfunctions: three-month results in 75 eyes

Purpose: To analyze the results of Descemet stripping and endothelial keratoplasty (DSEK) in the first consecutive 75 cases. Materials and Methods: Prospective, non-randomized, non-comparative interventional case series. Seventy-five eyes of 75 patients with endothelial dysfunctions of different etiology, scheduled for DSEK, were included in this study. Healthy donor cornea with a cell count of> 2000 cells/sq mm was considered for transplantation in each case. Indications, operative problems and postoperative complications were noted. Best corrected visual acuity (BCVA), refractive and keratometric astigmatism, central corneal thickness (CCT) and endothelial cell density (ECD) were analyzed for each patient after a minimum follow-up of three months. Results: Main indication was pseudophakic corneal edema and bullous keratopathy in 53 (70.7%) eyes. Seventeen (22.7%) cases had moderate to severe Fuchs' dystrophy with various grades of cataract; and DSEK was combined with manual small-incision cataract surgery (MSICS) with posterior chamber intraocular lens (PCIOL) in those cases. After three months, BCVA was 20/60 or better in 62 (82.7%) cases. Mean refractive and keratometric astigmatism were 1.10 +/- 0.55 diopter cylinder (DCyl) and 1.24 +/- 0.92 DCyl. The CCT and ECD were 670.8 +/- 0.32 microm and 1485.6 +/- 168.6/sq mm respectively. The mean endothelial cell loss after three months was 26.8 +/- 4.24% (range: 13.3-38.4%). Dislocation of donor lenticule occurred in six (8.0%) eyes. Graft failure occurred in one case. Conclusions: Descemet stripping and endothelial keratoplasty is a safe and effective procedure in patients with endothelial dysfunctions with encouraging surgical and visual outcomes. It can be safely combined with MSICS with PCIOL in patients with moderate to severe Fuchs' dystrophy with cataract.     

角膜后弹力膜内皮移植术研究进展

角膜后弹力膜内皮移植术由于具有相对较低的移植排斥率以及较好的视力预后等优势,目前已成为部分发达国家治疗角膜内皮失代偿的主流手术方式,但限于手术难度较高,学习曲线较长,中国人前房偏浅,加之国内角膜内皮病变往往合并有其他较复杂的眼部疾病,目前国内尚未普遍开展这一手术。本文就角膜后弹力膜内皮移植术的手术适应证、供体植片制备(...     

A modified method for suprachoroidal fluid drainage in kissing choroidal detachment

AIM: To introduce a new method for suprachoroidal fluid drainage before 23-gauge pars plana vitrectomy. METHODS: A 15º side-port blade was firstly used to create a sclerotomy into the suprachoroidal space for initial drainage. A 30-guage needle was then applied to inject balanced saline solution through the existing sclerotomy for further drainage. After most of the suprachoroidal fluid was drained, standard 3-port 23-guage pars plana vitrectomy was performed. RESULTS: We have succeeded in using this technique to treat five patients with retinal detachment and kissing choroidal detachment (KCD). The choroidal detachment was visibly recessed in all cases after drainage with no intraoperative complications. After removal of silicon oil at 3mo follow-up, all patients obtained a reattached retina. No postoperative complications such as hypotony and endophthalmitis occurred. CONCLUSION: The new technique is efficient and safe for suprachoroidal fluid drainage for patients with rhegmatogenous retinal detachment. In future, further larger series are needed to attest to its safety and ef?cacy.     

Graft survival and endothelial outcomes in the new era of endothelial keratoplasty

Corneal endothelial cells do not proliferative in?vivo sufficiently to enable endothelial regeneration, and thus diseases of the corneal endothelium, which cause poor vision and discomfort, require treatment by transplantation of cadaveric donor corneal endothelial cells. The two major goals of any corneal transplant procedure are to restore vision and to promote longevity of the donor cornea by maintaining a healthy donor endothelial cell density. Over the last decade, the surgical treatment for endothelial disease has rapidly evolved toward endothelial keratoplasty, or selective tissue transplantation, and away from full-thickness penetrating keratoplasty (PK). While endothelial keratoplasty offers distinct advantages over PK in terms of visual outcomes and a smaller incision, the new surgical manipulations of the fragile donor tissue cause significant donor endothelial cell trauma. As a result, donor endothelial cell loss is much higher during the first month after Descemet stripping endothelial keratoplasty (DSEK) compared to after PK, and the primary (or more appropriately, iatrogenic) graft failure rate of 5% remains unacceptably high. Nevertheless, the rate of endothelial cell loss rapidly decreases beyond 6 months after DSEK, and thus endothelial cell loss at 5 years after DSEK appears to be lower than that at 5 years after PK. In the absence of primary (iatrogenic) graft failure, graft survival through 5 years after DSEK is similar to that after PK. Given the promising longer-term endothelial outcomes of DSEK, the quest for optimizing the visual outcomes has spurred interest in Descemet membrane endothelial keratoplasty (DMEK). While early results after DMEK suggest better visual outcomes than after DSEK, the technique needs to be simplified, and longer-term outcomes must show an advantage over DSEK with respect to vision, endothelial cell loss, and graft survival. DMEK also has a high rate of primary (iatrogenic) graft failure, and additional donor tissue wastage occurs when preparation of DMEK grafts is unsuccessful. This review discusses endothelial keratoplasty techniques and the associated endothelial outcomes.     

Comparison of corneal haze and visual outcome in primary DSAEK versus DSAEK following failed DMEK

Background

Descemet membrane endothelial keratoplasty (DMEK) is being proposed as the procedure of choice in corneal endothelial disease as it achieves better visual and refractive outcomes than Descemet stripping automated endothelial keratoplasty (DSAEK). Nevertheless, primary graft failure is frequent, especially during the learning curve, and secondary back-up procedure consists on DSAEK. We aim to compare corneal haze and visual acuity of patients undergoing primary DSAEK vs. patients undergoing DSAEK as a back-up procedure after primary DMEK failure.

Methods

This study is a comparative case series that included 19 eyes from 16 patients with early stages of corneal failure and limitation of daily activities after primary DSAEK or secondary DSAEK. A control group of non-operated corneas included 10 aged-matched normal eyes. The study was conducted at University Hospital Ramón y Cajal and Vissum Hospital, Madrid, Spain. Corneal densitometry readings and postoperative best-corrected visual acuity in subjects with primary and secondary DSAEK were recorded 6 months after the surgery using the Pentacam Scheimpflug system (Oculus, inc.,Wetzlar, Germany).

Results

In primary DSAEK median densitometry values (range) were statistically significantly higher (p?<?0.05) than normal subjects for the full thickness, posterior and anterior part of the paracentral cornea; and the anterior part of the central cornea. In secondary DSAEK, median densitometry values were statistically significantly higher than normal subjects at all levels of the central and paracentral cornea. In secondary DSAEK, median densitometry values (range) were statistically significantly higher than in primary DSAEK in the full-thickness, anterior part and interface of the central cornea and in the full-thickness and posterior part of the paracentral cornea. Median visual acuity between groups (p?=?0.47) was statistically better for the primary DSAEK group, which also had a higher percentage of patients achieving BCVA of ≥ 20/40 and ≥20/25 than the secondary DSAEK group (100 % vs. 62 % and 60 % vs. 0 % respectively).

Conclusions

There is an increase in central corneal light scattering after secondary DSAEK performed after a failed DMEK as compared to primary DSAEK. This has a negative impact on final visual acuity that needs to be considered in each patient when starting DMEK surgery.     

Standardized ‘no‐touch’ donor tissue preparation for DALK and DMEK: harvesting undamaged anterior and posterior transplants from the same donor cornea

Purpose: To describe a standardized ‘no‐touch’ harvesting technique of anterior and Descemet membrane (DM) grafts for use in deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK), which provides undamaged anterior and posterior corneal grafts. Methods: A retrospective evaluation was performed of our standard method for harvesting DM grafts and DALK grafts (Technique I; n = 31) versus a newly designed ‘no‐touch’ technique (Technique II; n = 31), in which a peripheral ring of trabecular meshwork tissue is left in‐situ, and the DM graft is trephined on an underlying soft contact lens. Endothelial cell density (ECD) before and immediately after DM stripping was used as the main outcome parameter. Results: Endothelial cell density did not differ within Techniques I and II (before versus after DM stripping) (p = 0.75 and p = 0.54, respectively) or among Techniques I and II (p = 0.61). With the latter technique, anterior corneal grafts and posterior DM grafts could be harvested with negligible damage to the endothelial cell layer or the posterior stromal bed. All 93 grafts (62 DM grafts) were eligible for transplantation, and six months post‐operatively all transplants used were functional. Conclusion: The new technique offers the following advantages: (i) production of ‘undamaged’ grafts for DALK and DMEK, (ii) better controlled tissue handling of the thin DM graft during DM stripping and (iii) an increase in availability of corneal grafts obtained from the same donor tissue pool.     

Clinical outcomes after Descemet’s stripping endothelial keratoplasty using donor corneas from children younger than 3 years

Importance

There is limited literature on paediatric donors in endothelial keratoplasty.

Background

This study investigated the efficacy of and appropriate paediatric donor age for Descemet’s stripping endothelial keratoplasty (DSEK).

Design

Retrospective and observational case series.

Participants

Thirty‐eight consecutive patients underwent DSEK with paediatric donor corneas.

Methods

The age of the donors ranged from 32 weeks gestation (premature neonate) to 3 years old. All donor consents were obtained from the parents. The causes of donor death included traffic accident, congenital heart disease and neonatal respiratory distress syndrome.

Main Outcome Measures

The outcome measures included best‐corrected visual acuity, endothelial cell loss and complications.

Results

Best‐corrected visual acuity at last follow‐up was >20/40 in 28 of 38 eyes (73.7%). The mean preoperative endothelial cell density of donor corneas was 4682 ± 520 cells/mm². The mean endothelial cell density of grafts was 3977 ± 556 cells/mm² at 18 months postoperatively. Three lenticules from premature neonate donors exhibited severe contraction postoperatively. The edge of six lenticules from donors <1‐year‐old exhibited contraction in the early postoperative period and gradually flattened spontaneously. Graft detachment occurred in one patient.

Conclusions and Relevance

DSEK with paediatric donor corneas can achieve good clinical outcomes. The corneal lenticules from 1‐ to 3‐year‐ old donors are suitable for DSEK while those from donors <1‐year‐old are less suitable due to the possibility of severe postoperative graft contraction.     

Making the transition from PK to DSEK: experiences during the learning curve

Purpose: To report our experiences during the transition from penetrating keratoplasty to Descemet’s stripping with endothelial keratoplasty (DSEK). Methods: All patients undergoing DSEK during the period of April 2008 to April 2009 were included in this study. Results: All grafts were attached and clear at both the 6‐ and 12 ‐month follow‐up examinations. Mean best‐corrected visual acuity was 0.6 at 6 months and 0.7 at 12 months for patients without other ocular comorbidity. Conclusion: With adequate attention to detail, DSEK seems to be a safe and successful treatment for corneal endothelial disease, also during the surgeon’s learning curve.     

Descemet stripping and automated endothelial keratoplasty (DSAEK) in eyes with failed penetrating keratoplasty

PURPOSE: To report our results of using Descemet stripping and automated endothelial keratoplasty (DSAEK) in eyes with failed penetrating keratoplasty (PK). METHODS: An institutional review board-approved, prospective, surgical case series of 7 eyes of 7 consecutive patients undergoing DSAEK for graft failure after 1 or more PKs at 1 academic eye center. RESULTS: The mean follow-up period was 13.3 months (range, 9-18 months). One eye suffered recurrent donor graft dislocation and elected to undergo repeat PK instead of repeat DSAEK. Of the remaining 6 patients, the average preoperative visual acuity (VA) was 20/851 compared with a best-corrected visual acuity (BCVA) of 20/65 postoperatively (P = 0.008). After DSAEK, 6 (100%) eyes showed improved BCVA, and 4 of 6 eyes (67%) achieved a BCVA of 20/40 or better. All 6 grafts remained clear at the last follow-up visit. Two eyes showed graft dislocation on the first postoperative day and underwent repositioning of the lenticule with good results. Two other eyes were diagnosed with primary iatrogenic graft failure within 1 week of DSAEK and underwent repeat DSAEK with new donor tissue with good results. One eye experienced acute graft rejection that was successfully treated with topical steroids. CONCLUSIONS: This pilot series of DSAEK in eyes with graft failure from previous PK shows favorable VA and graft clarity outcomes. The complications observed were similar to those observed for DSAEK for Fuchs dystrophy and pseudophakic bullous keratopathy and include graft dislocation, iatrogenic graft failure, and homograft rejection.     

Komplikationsvermeidung und -management bei „Descemet membrane endothelial keratoplasty“ (DMEK) und „Descemet stripping automated endothelial keratoplasty“ (DSAEK)

Background

Posterior lamellar keratoplasty, in the form of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK), has become a standard procedure for therapy of endothelial diseases of the cornea. The aim of this article is to describe strategies to prevent and manage complications in DMEK and DSAEK surgery.

Methods

The article is based on a PubMed literature search and own clinical data. Key words used were “DMEK”, “DSAEK”, “Descemet membrane endothelial keratoplasty” and “Descemet stripping automated endothelial keratoplasty”.

Results

The DMEK and DSAEK procedures are safe surgical strategies for treating endothelial corneal diseases if the indications are made correctly.

Conclusions

The DMEK procedure is the standard procedure for improvement of visual acuity especially for younger patients with Fuchs’ dystrophy and DSAEK is particularly suitable for eyes with complicated anterior chamber situations.