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.     

Interface blood after descemet stripping automated endothelial keratoplasty

The authors report a case of a Descemet stripping automated endothelial keratoplasty that was complicated by intraoperative bleeding from the iridotomy site. Slit-lamp examination on postoperative day 1 revealed significant amount of retained blood at the donor-recipient interface and a best-corrected visual acuity (BCVA) of 20/400. The patient was managed with periodic observation and a topical fluoroquinolone and 1% prednisolone. By postoperative month 8, the interface had cleared, and the BCVA improved to 20/50. The patient remained with a clear cornea and stable BCVA of 20/50 at her most recent 1-year postoperative follow-up examination. Performing an intraoperative peripheral iridotomy to reduce the risk of air-associated pupillary block introduces the risk of its inherent complications, including intraoperative bleeding, retained blood cells at the interface, and delayed visual recovery. In this case, periodic observation and conservative management with topical steroids resulted in the resolution of the interface debris, associated keratitis, and improved postoperative visual acuity.     

Cost-effectiveness of Descemet stripping automated endothelial keratoplasty versus penetrating keratoplasty in patients with endothelial dysfunction in India

Purpose:The aim of this study was to compare the cost-effectiveness and perform cost-utility analysis of Descemet stripping automated endothelial keratoplasty (DSAEK) vs. penetrating keratoplasty (PK) in Indian population.Methods:This was an institutional, ambispective, observational study. Patients who underwent PK or DSAEK for endothelial dysfunction were included and followed up for 2 years; those with other ocular comorbidities were excluded. The analysis was performed from the patient’s perspective receiving subsidized treatment at a tertiary care hospital. Detailed history, ophthalmic examination, total expenditure by patient, and clinical outcomes were recorded. The main outcome measures were best spectacle-corrected visual acuity (BSCVA), graft survival (Kaplan–Meier survival estimates), incremental cost-effectiveness ratio (ICER), and incremental cost-utility ratio (ICUR). Utility values were based on quality-adjusted life years (QALYs) associated with visual acuity outcomes. Statistical analysis was performed using SPSS software package, version 12.1; a value of P < 0.05 was considered statistically significant.Results:A total of 120 patients (PK: 60, DSAEK: 60) were included. At 2 years, for a similar logMAR BSCVA, [PK (0.32 ± 0.02), DSAEK (0.25 ± 0.02); P = 0.078], the overall cost for PK (13511.1 ± 803.3 INR) was significantly more than DSAEK (11092.9 ± 492.1 INR) (difference = 1952.6 INR; P = 0.01). ICER of DSAEK relative to PK was –39,052 INR for improvement in 1 logMAR unit BSCVA. ICUR of DSAEK relative to PK was –1,95,260 INR for improvement in 1 QALY.Conclusion:DSAEK was more cost-effective than PK in patients with endothelial dysfunction at 2 years.     

Descemet stripping automated endothelial keratoplasty in pediatric age group

PurposeTo report the outcomes of DSAEK surgery performed in pediatric patients.DesignNoncomparative interventional case series.Subjects and methodsAll pediatric patients (age up to 16 years) undergoing Descemet automated stripping endothelial keratoplasty (DSAEK) at our Institution since January 2008 have been enrolled in a prospective study. A standard DSAEK, involving delivery of an 8.5–9.5 mm graft by Busin glide, was performed under general anesthesia in 19 eyes of 11 pediatric patients (congenital hereditary endothelial dystrophy n = 13; congenital glaucoma n = 2; posterior polymorphous dystrophy n = 2, and failed penetrating keratoplasty n = 2). Slit-lamp examination, refraction and visual acuity as well as endothelial cell density were evaluated preoperatively as well as 1, 3, 6, 12, and 18 months postoperatively.ResultsAll surgical procedures were uneventful. Graft detachment occurred in 4 cases and was managed successfully with repeat air injection. All corneas cleared within a week from surgery. Follow-up was 3–18 months. At last follow-up examination, best-corrected visual acuity (BCVA) was better than 20/40 in 8 of the 13 cases of patients old enough to assess vision. A graft rejection episode was seen in 1 case within 3 months from surgery but was reverted with steroidal treatment. No graft failures were observed.ConclusionsDSAEK is an appropriate surgical intervention for children with corneal endothelial failure. In contrast to penetrating keratoplasty (PK), DSAEK is performed under “closed system” conditions, thus minimizing intraoperative risks. Finally, healing is much faster than with PK and all sutures can be removed within 2–4 weeks from surgery, thus allowing fast visual recovery and prompt starting of amblyopia treatment.