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

Abstract

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 µm 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.

Documenting Visual Outcome of Descemet`s Stripping Endothelial Keratoplasty in A Tertiary Care Setting From Gujarat

“…Our study had younger population as compared to other studies. In our study, the major indication for DSEK was pseudophakic bullous keratopathy which contributed to 43(86%) cases, similarly in a study done by Basak et al (2008) 6 pseudophakic bullous keratopathy/ corneal edema in 53 (70.7%) cases was the main indication, whereas Fuch's endothelial dystrophy was the main indication of DSEK …”

“…Several studies in nonIndian populations published in the past 5 years show longterm benefits of DSEK, as well as a variation on the procedure with an automated microkeratome in a procedure known as Descemet's stripping automated endothelial keratoplasty, or DSAEK. 6 Descemet`s stripping endothelial keratoplast (DSEK) with its technical advantages and manageable complications is rapidly becoming the preferred treatment for corneal endothelial dysfunction but majority of evidence from Western literature cites use of a 9 mm graft.…”

Ceratoplastia endotelial com desnudamento da Descemet(DSEK) utilizando o dispositivo TAN EndoGlideTM: série de casos

“…Nos procedimentos lamelares posteriores, devido à inserção de tecido, a espessura da córnea aumenta, levando a redução do espaço na CA e a indução de hipermetropia (3,21) . No nosso estudo, 8 dos 9 pacientes (88,89%), apresentaram hipermetropia leve, o que coincide com os dados da literatura.…”

“…As células do endotélio humano raramente se proliferam in vivo. Devido a esta falta de capacidade proliferativa, o tratamento mais comumente preconizado nos casos de disfunção endotelial com perda de transparência da córnea é a ceratoplastia penetrante (PK) (2,3) . Esta técnica, realizada com o olho aberto, tem como desvantagem maior risco de complicação intraoperatória, maior chance de rejeição ou infecção e pode induzir astigmatismo alto e irregular comprometendo a qualidade visual final (4) .…”

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“…1 However, because of the lack of sutures between the graft and recipient tissue, graft dislocation ranks as the most-frequent early postoperative complication of DSEK (which was not an issue with penetrating keratoplasty). [2][3][4][5][6][7][8][9][10][11][12] As reported by the American Academy of Ophthalmology, dislocation rates varied from 0% to 82%, with a mean rate of 14.5%. 1 Several modifications have been suggested to improve graft attachment: scraping the peripheral recipient stroma to expose stromal fibres, 8 massaging to move any entrapped fluid out of the graft/host interface, extending the postoperative air bubble and face-up positioning duration, and creating small, peripheral, and stab incisions to evacuate the interface fluid have reportedly been used to decrease the rate of detachment.…”