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M.A. Terry, K. Hoar, J. Wall; Endothelial Keratoplasty (DLEK and DSEK): 3 Steps to Prevent Dislocations . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2376.
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The reported dislocation rate in DLEK is 4% and in DSEK/DSAEK is 10–25%. Based on our prior electron microscopy studies of interface morphology we added peripheral bed scraping to our usual surgical regimen of DSEK/DSAEK in order to reduce or eliminate donor tissue dislocation.
30 consecutive eyes in a prospective study underwent DSEK/DSAEK surgery for endothelial failure. The 3 steps utilized to prevent dislocation were: 1.) Peripheral recipient bed scraping prior to donor insertion, 2.) Surface sweeping with compression to remove interface fluid, 3.) and 10 minutes of an undisturbed anterior chamber air bubble intraoperatively. No incisions to drain interface fluid were utilized and a minimal residual air bubble was left behind with the patient kept supine for 1 hour post–op.
There were 0 dislocations in this series. Both the central and peripheral interface post–operatively were clear.
Intra–operative recipient bed scraping combined with compressive removal of interface fluid substantially eliminates donor dislocation in endothelial keratoplasty, without the need for post–operative air bubble manipulations or corneal drainage incisions.
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