Descemet's Stripping And Endothelial Keratoplasty For Pseudophakic Bullous Keratopathy: Simplified Manual Donor Dissection Without An Artificial Anterior Chamber

AimTo describe the long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with an anterior chamber intraocular lens (ACIOL) compared to secondary posterior chamber (PC) IOL.MethodsThis was a retrospective comparative cohort study. The clinical data of 82 eyes from 82 consecutive patients with pseudophakic (PBK) or aphakic bullous keratopathy (ABK) who either underwent DSAEK with retained or secondary ACIOL (n=23) or DSAEK with IOL exchange and/or secondary PCIOL (retropupillary iris-claw IOL, n=25; intrascleral-fixated IOL, n=29; or sulcus IOL, n=5) were analysed. The main outcome measures were graft survival and complications up to 5 years.ResultsThe graft survival in the secondary PCIOL group was superior than the ACIOL group over 5 years (year 1, 100.0% vs 100.0%; year 3, 94.7% vs 75.0%; year 5, 91.1% vs 60.6%, p=0.022). The presence of an ACIOL was a significant risk factor associated with graft failure (HR, 4.801; 95% CI, 1.406 to 16.396, p=0.012) compared to a secondary PCIOL. There was no significant difference in the rate of graft detachment and elevated intraocular pressure between the groups. There were five cases (9.3%) of IOL subluxation or dislocation in the retropupillary iris-claw and intrascleral-fixated IOL groups.ConclusionsEyes that underwent DSAEK with ACIOL in situ had poorer long-term graft survival compared with those with secondary PCIOL. Intraocular lens exchange was not associated with a higher complication rate. In ABK or PBK eyes with ACIOL, we recommend performing IOL exchange and/or secondary PCIOL implantation combined with endothelial keratoplasty.

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Outcomes of Resident-Performed Descemet's Stripping Automated Endothelial Keratoplasty

Journal of Academic Ophthalmology ◽

10.1055/s-0037-1609035 ◽

2017 ◽

Vol 09 (01) ◽

pp. e26-e31

Author(s):

Tatyana Beketova ◽

Margaret Pfeiffer ◽

Alice Chuang ◽

Gene Kim

Keyword(s):

Graft Failure ◽

Glaucoma Patient ◽

Case Series ◽

Glaucoma Surgery ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Ocular Surgery ◽

Pseudophakic Bullous Keratopathy ◽

Primary Graft Failure

Purpose This article aimed to evaluate outcomes of resident-performed Descemet's stripping automated endothelial keratoplasty (DSAEK). Methods This is a case series of patients who underwent DSAEK performed by PGY-4 ophthalmology residents at Lyndon B. Johnson Hospital from January 2013 to August 2016 staffed by a fellowship-trained cornea specialist. Patients with less than 1 month of follow-up were excluded. Demographics, baseline ocular characteristics, and intraoperative data were recorded. Vision and graft status were recorded at 1 week, 1 month, 3 months, and the last follow-up visits. Surgical failure was defined as graft detachment within 1 week of surgery and/or primary graft failure within 3 months of surgery. Results Eighteen eyes of 18 patients who followed up for 14.9 months (±12.9) were included. Mean age of patients was 60.9 years (±13.2). Indications for DSAEK included pseudophakic bullous keratopathy (10), Fuchs endothelial dystrophy (4), and other causes of endothelial dysfunction (4). Eleven (61%) eyes had prior ocular surgery, and 7 (39%) had prior glaucoma surgery. There were no postoperative graft detachments and two (11%) primary graft failures. There was one primary graft failure in a glaucoma patient. Of the 16 graft successes, logMAR visual acuity improved by 0.46 logMAR (±0.73) from baseline. Conclusion With appropriate staffing by an experienced cornea surgeon, DSAEK with residents as the primary surgeons is a safe and effective procedure with reasonably good outcomes.

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Clinical Evaluation of the NS Endo-Inserter, a Novel Donor Inserter for Descemet’s Stripping Automated Endothelial Keratoplasty

Case Reports in Ophthalmology ◽

10.1159/000503441 ◽

2019 ◽

Vol 10 (3) ◽

pp. 357-364

Author(s):

Akira Kobayashi ◽

Hideaki Yokogawa ◽

Natsuko Mori ◽

Tsubasa Nishino ◽

Kazuhisa Sugiyama

Keyword(s):

Anterior Chamber ◽

Clinical Outcomes ◽

Intraoperative Complications ◽

Case Series ◽

Argon Laser ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Donor Tissue ◽

Laser Iridotomy ◽

Cell Densities

Purpose: This study investigated the clinical outcomes achieved with a newly developed donor inserter (NS Endo-Inserter [NSI], HOYA Co., Ltd., Tokyo, Japan) for Descemet’s stripping automated endothelial keratoplasty (DSAEK) in Japanese eyes with bullous keratopathy secondary to argon laser iridotomy (BK-ALI). The NSI device utilizes pressure flow to push the DSAEK donor tissue into the anterior chamber. Methods: Six eyes of 6 patients (1 male, 5 females; mean age, 78.5 years) with BK-ALI were enrolled. Donor tissue was pushed into the anterior chamber using the NSI. Intraoperative complications, graft dislocation, and iatrogenic primary graft failure were recorded for all eyes. Six-month postoperative central donor endothelial cell densities (ECD) were measured prospectively and compared with preoperative values, along with 6-month best corrected visual acuity (BCVA). Results: In all cases, donor loading onto the NSI spatula and donor insertion into the anterior chamber using the NSI was smooth and successful; no intraoperative complications were noted. There were no cases of graft dislocation or IPGF. Postoperative ECD was 2,187.2 cells/mm2 (mean loss, 14.8%) and mean BCVA increased from 0.27 decimal to 0.8 at 6 months. Conclusion: In this small preliminary case series, clinical outcomes for patients with BK-ALI undergoing DSAEK using the NSI were comparable or better than those achieved with conventional DSAEK insertion techniques.

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