No abstract

PURPOSE: To evaluate early visual and refractive outcomes following treatment of corneal endothelial dysfunction with a corneal transplantation technique, Descemet's stripping with endothelial keratoplasty (DSEK). METHODS: Visual and refractive outcomes of the first 50 consecutive cases of DSEK performed by a single surgeon between December 2003 and July 2004 were analyzed retrospectively. The DSEK technique consisted of stripping Descemet's membrane and endothelium from a recipient cornea and transplanting the posterior stroma and endothelium of a donor cornea through a 5-mm incision. RESULTS: Results are reported for 50 eyes in 47 patients (30 women and 17 men). Mean patient age at surgery was 70±12 years (range: 34 to 89 years). Five eyes were treated for corneal edema or bullous keratopathy and 45 for Fuchs' endothelial dystrophy. Seven eyes were phakic and 43 were Pseudophakic. Six months after surgery, mean manifest cylinder was 1.5±0.94 diopters (D), unchanged from preoperative cylinder of 1.5±1.0 D. Mean manifest spherical equivalent refraction was 0.15 ±1.5 D at 6-month follow-up compared with -0.36±1.4 D preoperatively (P=.10) At 3- and 6-month follow-up, significant improvement was noted in mean best spectacle-corrected visual acuity compared with the preoperative mean of 20/100 (P=.007). At 6-month follow-up, 31 (62%) eyes refracted to ≥20/40 and 38 (76%) eyes saw ≥20/50. CONCLUSIONS: Compared to standard penetrating keratoplasty, DSEK causes minimal refractive change and provides rapid visual recovery for patients with endothelial dysfunction. This technique maintains the structural integrity of the cornea by preserving the recipient's epithelium, Bowman's layer, and entire stromal thickness. [J Refract Surg. 2005;21:339-345.]

No abstract

No abstract

Suture-fixated PCIOLs can dislocate due to degradation of the suture material over time. The use of larger diameter (9-0 instead of 10-0) polypropylene suture material and placement of the haptic and sutures in the ciliary sulcus to promote attachment of scar tissue may enhance the long-term stability of scleral-fixated PCIOLs.

No abstract

No abstract

Purpose-To assess outcomes 1 year after Descemet's stripping automated endothelial keratoplasty (DSAEK) in comparison with penetrating keratoplasty (PKP) from the Specular Microscopy Ancillary Study (SMAS) of the Cornea Donor Study. Design-Multicenter, prospective, nonrandomized clinical trial.Participants-A total of 173 subjects undergoing DSAEK for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema) compared with 410 subjects undergoing PKP from the SMAS who had clear grafts with at least 1 postoperative specular image within a 15-month follow-up period.Methods-The DSAEK procedures were performed by 2 experienced surgeons per their individual techniques, using the same donor and similar recipient criteria as for the PKP procedures in the SMAS performed by 68 surgeons at 45 sites, with donors provided from 31 eye banks. Graft success and complications for the DSAEK group were assessed and compared with the SMAS group. Endothelial cell density (ECD) was determined from baseline donor, 6-month (range, 5-7 months), and 12-month (range, 9-15 months) postoperative central endothelial images by the same reading center used in the SMAS. Main Outcome Measures-Endothelial cell density and graft survival at 1 year.Results-Although the DSAEK recipient group criteria were similar to the PKP group, Fuchs' dystrophy was more prevalent in the DSAEK group (85% vs. 64%) and pseudophakic corneal edema was less prevalent (13% vs. 32%, P<0.001). The regraft rate within 15 months was 2.3% (DSAEK group) and 1.3% (PKP group) (P = 0.50). Percent endothelial cell loss was 34±22% versus 11±20% NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript (6 months) and 38±22% versus 20±23% (12 months) in the DSAEK and PKP groups, respectively (both P<0.001). Preoperative diagnosis affected endothelial cell loss over time; in the PKP group, the subjects with pseudophakic/aphakic corneal edema experienced significantly higher 12-month cell loss than the subjects with Fuchs' dystrophy (28% vs. 16%, P = 0.01), whereas in the DSAEK group, the 12-month cell loss was comparable for the 2 diagnoses (41% vs. 37%, P = 0.59). A number of studies suggest that 6-month cell loss is significantly higher after endothelial keratoplasty than PKP. [5][6][7][8] Only 2 published DSAEK studies have reported cell loss to 2 years. In both, the cell loss increased by only 6% to 7%, relative to the baseline donor ECD, between 6 months and 2 years. 5,8 These were relatively modest increases compared with the 25% increase in cell loss seen in a comparable time period in the SMAS PKP eyes. 1 Limited data have been reported on relative graft survivals for endothelial keratoplasty versus PKP. Conclusions-OneThe ideal approach to determine any statistically and, more important, clinically significant differences in endothelial cell loss and graft success after DSAEK and PKP would be with a prospective, randomized study using the same donor pair and a central reading center to determine ECD on the donor an...