Descemet Stripping Endothelial Keratoplasty (DSAEK) Following Penetrating Keratoplasty (PK)

1
Descemet Stripping Endothelial Keratoplasty
(DSAEK) Following Penetrating Keratoplasty (PK)

• Amit Patel, FRCOphth
• Massimo Busin, MD
• Villa Serena Hospital, Forli, Italy
• Fondazione Banca degli Occhi del Veneto, Venice,
  Italy
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• Financial Disclosure
• Pfizer (UK) Ophthalmic Fellowship Award (AP)
• Travel reimbursements and royalties from Moria,
  Antony, France (MB)

2
PURPOSE

• To Evaluate the Outcomes of DSAEK in Eyes With
  Post-Penetrating Keratoplasty (PK) Endothelial
  Decompensation.

3
METHODS

• Prospective Study
• January 2007 to June 2009
• Cause of Endothelial Failure
• UCVA, BCVA, ECC noted at 1, 3, 6, 12 and 24
  months post-DSAEK
• Complications

4
SURGICAL TECHNIQUE

• Descemetorhexis Within PK wound and Peripheral
  Iridotomy
• Graft Delivery with Busin Glide Through a 3.2mm
  Clear-Corneal Tunnel

5
SURGICAL TECHNIQUE

• 8.5 to 9.0mm Donor Button(arrows) Centered on the
  Limbus Regardless of the PK Wound
• Air Fill to Achieve Graft Attachment Air-tight
  Suturing of All Wounds

6
RESULTS

• 31 Cases Recruited
• 29/31 Immunologic Graft Failure
• All DSAEK Grafts Larger than Original PK(8.5-9.0
  mm vs 7.5-8.0 mm)

7
RESULTS

• All Grafts Attached (1 case Required Re-bubbling)
• Average Follow up 9.8 Months (Range 3-24 Months)
• ECL at 1 year 27.5 16/31 eyes
• No Graft Failures at Last Follow up

8
RESULTS

• Visual Outcomes
• Pre-op BCVA lt20/200 in 30/31 cases
• Post-op BCVA
• Improved in 25/31 cases
• Unchanged in 6/31 cases

9
RESULTS

• Complications
• 1 Graft Detachment on 1st Postoperative Day
  (Successful Attachment with Re-bubbling)
• 1 PK Wound Dehiscence (sutured )
• 1 Immunologic Graft Rejection (Treated
  Successfully)

10
CONCLUSIONS

• DSAEK is Effective in Treating Post PK
  Endothelial Failure
• 2-Year Success Rate is High in Eyes with High
  Risk of Rejection in spite of a Diameter Larger
  than that of the Original PK