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Lucy A Bailey, Emily A Groenendaal, Eleni M Florakis, George J Florakis; Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK): Dislocation and Failure Rates-one surgeon’s first 245 cases. Invest. Ophthalmol. Vis. Sci. 2014;55(13):886.
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To examine donor and recipient characteristics associated with DSAEK graft dislocation and failure.
IRB-approved retrospective chart review of one surgeon’s first 245 DSAEK cases between 2006-12 at the Harkness Eye Institute. Donor cornea information, the patients’ preoperative history and postoperative course were reviewed. 245 procedures in 203 patients with a minimum of 1 year postoperative follow-up were included. In preliminary analysis, graft failure was defined as both primary and late graft failures. Statistical analysis was done with two-sided chi-squared and t tests of independent samples at a 5% significance level.
Mean age was 76.9. 65.5% were female. Preoperative diagnoses included Fuchs’ Dystrophy(46.3%), post-cataract surgery edema(39.9%), failed Penetrating Keratoplasty or DSAEK (12.8%), aphakic corneal edema(0.5%), and ICE Syndrome(0.5%). Overall success rate for primary DSAEK was 91.0%. After excluding the first 50 cases, success rate for primary DSAEK was 95.98%(n=195). Cases 1-50 had a dislocation rate of 20% and failure rate of 34%; 51-100 had a dislocation rate of 0% and failure rate of 6%; 101-150 had a dislocation rate of 10% and failure rate of 8%; 151-200 had a dislocation rate of 12% and failure rate of 2%; 201-245 had a dislocation rate in 0% with failure rate of 2.2%. In the first 100 cases, overall dislocation rate was 20% and failure rate was 34%. In cases 101-245, the dislocation rate was 5.6% and failure rate was 4.6%. Among all 245 cases (including the learning curve), dislocation rate was highest for previously-failed grafts(n=34)(17.7%), significantly different from the 7.1% dislocation rate for primary DSAEK(n=211)(p=0.04). 42.9%(n=9) of rebubbled grafts(n=21) ultimately failed, significantly different from the 7.6% rate for grafts without rebubbling(n=224). There was no significant association between graft failure or dislocation and donor characteristics including age, hours from death to preservation, preservation to use, and endothelial cell count, which were within the surgeon’s usual parameters.
The rate of dislocation and failure decreased with surgeon experience. The rate of dislocation among those with a previously-failed graft was significantly greater than the dislocation rate among those with a primary DSAEK. No significant association was found with the measured donor characteristics.
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