Outcomes of complex Descemet Stripping Endothelial Keratoplasty performed by cornea fellows

Abstract

BackgroundA major obstacle that academic institutions face is the steep learning curve for cornea fellows initially learning to perform Descemet Stripping Endothelial Keratoplasty (DSEK). The purpose of this study is to evaluate the outcomes of complex DSEK performed by cornea fellow supervised by an attending surgeon at an academic institution.MethodsPatients who underwent a complex DSEK procedure performed by a cornea fellow during the years 2009-2013 were included. All the surgeries were supervised by the same cornea attending. All patients had a minimum follow-up of 6 months. Charts were reviewed for demographic data, intraoperative and postoperative complications and clinical outcomes. Corneal graft survival was calculated using the Kaplan-Meier analysis.ResultsFifty-seven eyes of 55 patients (mean age 77.5 ± 8.5 years) were included in the study with a mean follow-up time of 16.4 ± 15.6 months. Previous graft failure, presence of a tube and history of trabeculectomy were the leading diagnoses to define the surgery as complex. No intraoperative complications occurred. In 21.1% of cases a corneal graft detachment was documented in the first postoperative day. Mean visual acuity improved from 1.06 LogMAR (20/230) preoperatively to 0.39 LogMAR (20/50, p < 0.001) by the sixth postoperative month and to 0.52 LogMAR (20/65, p < 0.001) at the last follow-up visit. Graft failure rate was 29.8%. Kaplan-Meier analysis found a 67.2% graft survival rate at 20 months.ConclusionsComplex DSEK can be performed successfully with an acceptable postoperative complication rate by cornea fellows during their training period when supervised by an experienced attending.

Comparative study of efficacy and safety between nDSEK and DSEK for bullous keratopathy

“…However, there were no signi cant statistical differences between the occurrence of this complication in nDSEK and DSEK eyes. The rate of acute high intraocular pressure was relatively lower, as compared to the 10.5% reported in the study conducted by Daubert et al [17] but higher than 2.8% reported by study of Basaket al [20]. The higher rate of acute high intraocular pressure in our present study could be associated with the use of a full intracameral air tamponade to obtain rm attachment of the donor at the end of surgery without releasing the air postoperatively.…”

“…First, eye conditions such as prior cataract-vitreous-retinal surgery (ocular trauma history ), glaucoma drainage implantation, complicated eye with severe corneal edema, abnormal anterior segment such as anterior synechia, aphakia, and iris defect, can make endothelial keratoplasty more challenging for these complex cases. Second, factors related to the surgery itself, such as incision size, donor tissue preparation, as well as graft delivery devices, rebubbling for donor tissue dislocation and the learning curve of EK for the surgeon [14,15,16,17] also associated with postoperative corneal endothelial loss. All of these factors can affect the ECL and lead to higher ECL as observed in our present study.…”

“…The most common complication encountered in endothelial keratoplasty is graft dislocation, which occurs at a wide range of rates, from 0-80%, with an average dislocation rate of 14.5% [18]. Several factors, such as the surgeon's experience, viscoelastic in the graft interface, geometric mismatch between donor and recipient curvatures that cause a portion of the donor to arc away from the recipient, residual strands of either stroma or Descemet membrane that prevent tight apposition of the donor against the recipient all can contribute to the in uence on the surgery [17,19]. In the present study, graft dislocation occurred in 8.3% nDSEK eyes and 3.6% DSEK eyes, with no signi cant variation between the nDSEK and DSEK groups.…”

Complications of Descemet stripping endothelial keratoplasty – A retrospective interventional study at a tertiary eye care center in Southern India

“…Several other authors have shown that donor dislocation is the most common complication seen in DSEK and with experience and time, the dislocation rate is reduced. [ 19 , 20 ] Cystoid macular edema and retinal detachment were not seen in any of the postoperative cases.…”