Descemet Stripping Automated Endothelial Keratoplasty Performed by Cornea Fellows

Abstract

Outcomes of DSAEK performed by cornea fellows supervised by the faculty members seems to be fairly acceptable.

Outcomes of penetrating keratoplasty in congenital hereditary endothelial dystrophy

“…Our experience of DSEK in CHED is limited to this case. The degree of stromal thickening and scarring and the presence of nystagmus, which can lead to detachment of the endothelial graft, contribute to poor DSEK outcomes in CHED 20. Mittal et al noted that DSEK is technically challenging in CHED because of the poor view through the opaque cornea and difficulty in Descemet’s membrane removal, which is firmly attached 3.…”

Descemet stripping automated endothelial keratoplasty

“…[3536373839404142434445464748495051525354555657585960616263646566676869707172] Figs. 1 and 2 show the postoperative outcomes after DSAEK and ultrathin DSAEK, respectively.…”

“…Analysis of the available studies suggests endothelial cell loss in the range of 25%–61% at 3-year follow-up. [1035447273] At 5 years follow-up, it has been reported to be around 51.9%. [52]…”

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

“…The authors reported a primary graft failure rate of 21.8% for the level 1 surgeon compared with 1.5% for the level 5 surgeon. 6 Hashemi et al reviewed the results of DSAEK surgery for cornea fellows and found graft detachment in 17 eyes (21.7%) and graft failure in 8 eyes (10.2%), 5 compared with a graft detachment rate of 2.7 and 8.9% and a graft failure rate of 4.1 and 3.0% in attending surgeons at a tertiary academic center in eyes without previous glaucoma surgery. 11,12 Given this steep learning curve, cornea specialists are hesitant to allow residents to be primary surgeons for DSAEK surgery, and to the best of our knowledge, we could not find any other publications in the literature discussing the results of residents as primary surgeons for DSAEK (PubMed search on May 14, 2017, using the terms "DSAEK" and "resident," or "DSAEK" and "novice").…”

“…Our graft detachment rate of 0% and primary graft failure rate of 11% are far better than those discussed in the literature for novice surgeons. 5,6 There are several technique variations that, we think, make our procedure easier for novice surgeons:…”