Postoperative supine position after primary Descemet-stripping automated endothelial keratoplasty reduces graft detachment rate

Safir, Margarita; Dubinsky‐Pertzov, Biana; Peled, Alon; Rozenberg, Assaf; Zadok, David; Avni, Isaac; Pras, Eran; Einan‐Lifshitz, Adi; Goldich, Yakov

doi:10.1016/j.jcjo.2021.04.012

Cited by 3 publications

(4 citation statements)

References 26 publications

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“…Evaluating 170 operated eyes in 138 patients, they observed a 16% patient noncompliance rate with instructions to perform supine posturing; in this cohort of noncompliant patients, the graft dislocation rate was 26%, compared with 13% in eyes in which the patients were compliant with posturing instructions. 11 This suggests that Descemet stripping automated endothelial keratoplasty grafts may be more vulnerable to postoperative detachments than DMEK grafts in the absence of air bubble support. Alternatively, it may be the case that poor compliance with postoperative instructions, itself, is associated with poor surgical outcomes, including graft adherence.…”

Section: Discussionmentioning

confidence: 99%

DMEK Without Postoperative Supine Posturing

Parker

Tate

et al. 2022

Cornea

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Purpose:The purpose of this study was to describe the incidence of graft detachment after Descemet membrane endothelial keratoplasty (DMEK) without postoperative supine posturing.Methods:A total of 106 eyes of 84 patients with Fuchs endothelial corneal dystrophy or bullous keratopathy (BK) were operated by a single experienced surgeon with DMEK with a 99% anterior chamber air bubble fill, recovered in an upright (seated) position, and then discharged without instructions to remain supine. Postoperatively, all eyes were evaluated for graft detachment through anterior segment optical coherence tomography at predetermined intervals (1 d, 1 wk, and 1 mo). Detachments were regarded as clinically significant if they subtended 30% of the total graft surface area or involved the visual axis.Results:Clinically significant graft detachments were observed in 23 of 106 eyes (22%) in the no-supine posturing cohort, including 22 of 85 eyes (26%) operated for Fuchs endothelial corneal dystrophy and 1 of 21 eyes (5%) operated for BK. Compared with a historical comparison group of eyes undergoing DMEK with 48 hours of postoperative supine posturing, the risk of graft detachment was not increased. In both cohorts, 6% of operated eyes required regrafting for either persistent detachment or primary graft failure. No additional intraoperative or postoperative complications were experienced.Conclusions:Particularly in eyes operated for BK, the supine posturing requirement after DMEK may be eliminated without increasing the absolute risk for clinically significant graft detachment.

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Section: Discussionmentioning

confidence: 99%

DMEK Without Postoperative Supine Posturing

Parker

Tate

et al. 2022

Cornea

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“…[ 27 ] Ensuring the patient is supine postoperatively and creating a bubble in the anterior chamber are some strategies to address endothelial detachment. [ 28 , 29 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of glaucoma therapy escalation after penetrating keratoplasty to descemet stripping automated endothelial keratoplasty for the treatment of pseudophakic bullous keratopathy: A cohort study

Aldarrab¹,

Alsakran²,

Al-Swailem³

et al. 2022

Middle East Afr J Ophthalmol

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PURPOSE: The purpose of this study was to compare glaucoma therapy escalation (GTE), graft survival, vision, and glaucoma following penetrating keratoplasty (PK group) and Descemet stripping automated endothelial keratoplasty (DSAEK group) to treat pseudophakic bullous keratopathy (PBK). METHODS: This cohort included cases of PBK managed with PK from 2009 to 2014. We compared the incidences and determinants of GTE, graft survival, and visual disability. P < 0.05 was statistically significant. RESULTS: There were 58 eyes in the PK group and 117 eyes in the DSAEK group. The incidence of GTE in the PK and DSAEK groups at the last follow-up was 34.2% (95% confidence interval [CI]: 19.5–48.9) and 46.6% (95% CI: 27.7–65.4), respectively. The risk of GTE was similar between the groups (relative risk [RR] = 1.36 [95% CI: 0.94–1.98], P = 0.12). GTE was significantly associated with graft survival in the PK group (RR = 3.25 [95% CI: 1.5–7.0], P < 0.001) and the DSAEK group (RR = 3.77 [95% CI: 2.6–5.6], P < 0.001). Glaucoma ( P = 0.001) and previous keratoplasty ( P < 0.001) were significant predictors for GTE. At the final follow-up visit, severe visual disability was not significantly different between the groups (RR = 0.9 [95% CI: 0.3–2.9], P = 0.88). There was a statistically significant improvement in vision after DSAEK ( P < 0.001) but not after PK ( P = 0.67). CONCLUSION: GTE was similar in eyes with PBK managed by PK or DSAEK. Glaucoma and previous keratoplasty were predictors of GTE post-keratoplasty. DSAEK gave better visual outcomes than PK for managing PBK.

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“…3,5,6 However, several patient-related factors have been linked with a higher detachment risk, including previous incisional glaucoma surgery, 7,8 previous fullthickness keratoplasty (PK), 9,10 low intraocular pressure, 11 a compromised lens-capsule barrier, 12 and inability of the patient to maintain postoperative supine positioning. 13,14 Considering the short-term and long-term implications of failure of the primary tamponade to ensure graft attachment, any easily reproducible surgical steps to reduce detachment rates in complex eyes should be a welcome advance in endothelial keratoplasty. The ability to reduce postoperative graft detachment may also influence whether to offer DSEK versus DMEK to patients with certain risk factors.…”

mentioning

confidence: 99%

“…3,5,6 However, several patient-related factors have been linked with a higher detachment risk, including previous incisional glaucoma surgery, 7,8 previous full-thickness keratoplasty (PK), 9,10 low intraocular pressure, 11 a compromised lens–capsule barrier, 12 and inability of the patient to maintain postoperative supine positioning. 13,14…”

mentioning

confidence: 99%

Suture Fixation to Reduce Graft Detachment in Descemet Stripping Endothelial Keratoplasty

Witsberger,

Oyemade,

Rauen

et al. 2023

Cornea

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Purpose: The aim of this study was to report the outcomes of graft fixation using interrupted, full-thickness sutures on graft detachment after Descemet stripping endothelial keratoplasty (DSEK). Methods: All DSEK procedures performed at Mayo Clinic, Rochester, MN, from 2015 through 2022 were retrospectively reviewed. Risk factors for graft detachment were defined as previous incisional glaucoma surgery, previous penetrating keratoplasty, or absence of the normal lens–capsule barrier. Cases were categorized into sutured, high-risk grafts; unsutured, high-risk grafts; and unsutured, low-risk grafts. The primary outcome was graft detachment, and secondary outcomes were early graft failure and graft clarity at 12 months after surgery. Results: Demographics between the high-risk groups were similar for sex and age at the time of surgery. Graft detachment occurred in 4 of 97 sutured, high-risk eyes (4.1%) and 24 of 119 unsutured high-risk eyes (20.2%) (P = 0.002). In comparison, graft detachment occurred in 18 of 181 unsutured low-risk eyes (9.9%). The incidence of early graft failure was 2.1%, 5.0%, and 3.3% and late graft failure by 12 months was 9.8%, 12.8%, and 4.2%, respectively. Conclusions: In eyes with high-risk factors for graft detachment, suture fixation of the graft in DSEK decreased graft detachment to a rate at least as low as that in low-risk eyes.

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Postoperative supine position after primary Descemet-stripping automated endothelial keratoplasty reduces graft detachment rate

Cited by 3 publications

References 26 publications

DMEK Without Postoperative Supine Posturing

DMEK Without Postoperative Supine Posturing

Comparison of glaucoma therapy escalation after penetrating keratoplasty to descemet stripping automated endothelial keratoplasty for the treatment of pseudophakic bullous keratopathy: A cohort study

Suture Fixation to Reduce Graft Detachment in Descemet Stripping Endothelial Keratoplasty

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