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Melissa Tripoli, Rebecca Kuennen; Effect of Topical Corticosteroids and Air Bubble Insertion Size and Duration on DSAEK Outcomes. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1220.
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© 2017 Association for Research in Vision and Ophthalmology.
To evaluate patients with a history of Fuchs Endothelial Dystrophy and corneal edema who have undergone Descemet’s Automated Endothelial Keratoplasty at the Ohio State University Wexner Medical Center, to record the difference’s in duration, dosage, and frequency of topical corticosteroid use post operatively and the variability in surgeon technique regarding air bubble management, and to evaluate if there is a difference in outcomes such as endothelial graft rejection, failure, and dislocation.
Retrospective chart review of patients who underwent Descemet’s Automated Endothelial Keratoplasty (DSAEK) from a time period of 01/01/2010 to 4/1/2015, which were identified by the proper CPT code. Diagnosis, topical corticosteroid dose, corticosteroid frequency, corticosteroid duration, visual acuity at 1 and 6 months, post operative refractive error change, and surgical technique including air bubble duration, and period of post operative observation were recorded. Additionally recorded were the incidences of graft dislocation, graft failure, and need for additional surgeries.
Charts from 91 patients from the Ohio State University Wexner Medical Center Department of Ophthalmology with a mean age of 72.9 that underwent DSAEK or DSAEK with cataract extraction were reviewed. The overall incidence of graft failure was 4% (n =91). Evaluation of air bubble duration found a median of 15 minutes, a mean of 25 minutes and a standard deviation of 19. There was a time range of 12-60 minutes, CI = 23-31. Looking at bubble duration versus graft failure, Pearson r value was equal to 0.062, with a P of 0.562. There was no correlation between bubble duration and graft failure. When analyzing postoperative corticosteroid duration in correlation to graft failure, the Pearson r value was 0.11, with a P equal to 0.315. There was no correlation between corticosteroid duration and graft failure.
This study confirmed that there is a difference between surgeon techniques in regards to air bubble duration during DSAEK. However this difference did not correlate to a difference in graft dislocation or graft failure rate. Also there was no statistically significant difference between corticosteroid duration and graft failure. There was a mean hyperopic shift following DSAEK alone of 1.3 diopters.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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