PURPOSE: We retrospectively analyzed the rate of graft detachment from 310 Descemet stripping endothelial keratoplasty (DSEK)/Descemet stripping automated endothelial keratoplasty (DSAEK) cases performed by a single surgeon over a 10-year period using same-day complete air removal. Secondary outcome measures including primary graft failure, late endothelial graft failure, rejection events, and steroid-induced ocular hypertension were also analyzed. METHODS: A retrospective chart review was performed on all patients receiving DSEK/DSAEK for any cause by the same surgeon at 2 separate institutions from January 2005 to December 2014. The air bubble used to promote graft-host apposition was completely removed after 1 hour. Descriptive statistical analysis was used to report the rates of graft detachment, and χ analysis was used to assess for associations with secondary outcomes. RESULTS: Among 310 endothelial keratoplasties analyzed, there were 19 graft detachments (6.1%). The graft detachment rate was higher during the learning curve, but rapidly declined with experience, and was 1.3% for the last 79 cases over a 4-year period. No primary graft failures were reported. The rate of steroid-induced ocular hypertension was 20%. The rate of graft failure was 8%. The rate of graft rejection events was 10.7%. Two of the 6 patients (33%) who underwent trabeculectomy before endothelial keratoplasty suffered a detachment. CONCLUSIONS: A graft detachment rate as low as 1.3% can be achieved in DSEK/DSAEK with same-day complete air removal shortly after surgery. Factors believed to contribute to a low detachment rate include complete interface fluid removal and reconstitution of the normal anterior chamber milieu to assist corneal endothelial function.
PURPOSE: We retrospectively analyzed the rate of graft detachment from 310 Descemet stripping endothelial keratoplasty (DSEK)/Descemet stripping automated endothelial keratoplasty (DSAEK) cases performed by a single surgeon over a 10-year period using same-day complete air removal. Secondary outcome measures including primary graft failure, late endothelial graft failure, rejection events, and steroid-induced ocular hypertension were also analyzed. METHODS: A retrospective chart review was performed on all patients receiving DSEK/DSAEK for any cause by the same surgeon at 2 separate institutions from January 2005 to December 2014. The air bubble used to promote graft-host apposition was completely removed after 1 hour. Descriptive statistical analysis was used to report the rates of graft detachment, and χ analysis was used to assess for associations with secondary outcomes. RESULTS: Among 310 endothelial keratoplasties analyzed, there were 19 graft detachments (6.1%). The graft detachment rate was higher during the learning curve, but rapidly declined with experience, and was 1.3% for the last 79 cases over a 4-year period. No primary graft failures were reported. The rate of steroid-induced ocular hypertension was 20%. The rate of graft failure was 8%. The rate of graft rejection events was 10.7%. Two of the 6 patients (33%) who underwent trabeculectomy before endothelial keratoplasty suffered a detachment. CONCLUSIONS: A graft detachment rate as low as 1.3% can be achieved in DSEK/DSAEK with same-day complete air removal shortly after surgery. Factors believed to contribute to a low detachment rate include complete interface fluid removal and reconstitution of the normal anterior chamber milieu to assist corneal endothelial function.
Authors: Harry Levine; Paula A Sepulveda-Beltran; Diego S Altamirano; Alfonso L Sabater; Sander R Dubovy; Harry W Flynn; Guillermo Amescua Journal: Cornea Date: 2022-02-01 Impact factor: 2.651
Authors: Muhammad Ali; Shahid Y Khan; John D Gottsch; Eric K Hutchinson; Aisha Khan; S Amer Riazuddin Journal: Stem Cell Reports Date: 2021-08-05 Impact factor: 7.765