June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Descemet Stripping and Automated Endothelial Keratoplasty Performed by Residents
Author Affiliations & Notes
  • Jun Shimazaki
    Department of Ophthalmology, Tokyo Dental College, Ichikawa, CHIBA, Japan
  • Daisuke Tomida
    Department of Ophthalmology, Tokyo Dental College, Ichikawa, CHIBA, Japan
  • Koji Kakisu
    Department of Ophthalmology, Tokyo Dental College, Ichikawa, CHIBA, Japan
  • Takefumi Yamaguchi
    Department of Ophthalmology, Tokyo Dental College, Ichikawa, CHIBA, Japan
  • Yoshiyuki Satake
    Department of Ophthalmology, Tokyo Dental College, Ichikawa, CHIBA, Japan
  • Footnotes
    Commercial Relationships   Jun Shimazaki, None; Daisuke Tomida, None; Koji Kakisu, None; Takefumi Yamaguchi, None; Yoshiyuki Satake, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 4782. doi:
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      Jun Shimazaki, Daisuke Tomida, Koji Kakisu, Takefumi Yamaguchi, Yoshiyuki Satake; Descemet Stripping and Automated Endothelial Keratoplasty Performed by Residents. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4782.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Surgical educations is an important issue in corneal transplantation. We have reported that outcomes of penetrating keratoplasty performed by residents were similar to those performed by an experienced surgeon (Shimmura-Tomita M, et al. J Surg Educ 2016). As Descemet stripping automated endothelial keratoplasty (DSAEK) becomes a leading surgical method for the treatment of bullous keratopathy (BK), surgical education for DSAEK attracts more attention. The purpose of the study is to compare the outcomes of DSAEK performed by residents with an experienced surgeon.

Methods : In this case control study, we analyzed outcomes of DSAEK performed by residents (R group. n=41) and by a single experienced surgeon (JS, E group, n=35). First 5 to 10 DSAEK cases performed by residents were analyzed. The residents had experiences for penetrating keratoplasty, and the surgery was performed under guidance with experienced surgeons. Graft clarity rate, incidence of postoperative complications, visual acuity, surgical time, and % endothelial cell loss at 1, 3, 6, and 12 months following surgery were studied.

Results : Both groups had similar preoperative status including age (P=0.94) and visual acuity (P=0.10). The leading causes for BK included laser iridotomy-induced BK and pseudophakic BK. Surgical time was significantly longer in R group compared with E group (67.6 vs. 49.2 minutes, P=0.0013) At 12 months, graft clarity was maintained in 100% and 97.1% of cases in R and E groups, respectively. Three and one eyes in the R and E groups, respectively, later developed endothelial decompensation. Mean corrected visual acuity was significantly better in E group compared with that in R group at 6 (P=0.031) and 12 months (P=0.0044) postoperatively. Mean corneal endothelial cells loss at 12 months was 56.5±18.9 % and 44.0±24.5% in R and E groups, respectively (P=0.077). Postoperative double chamber/graft dislocation was observed in 6 and 4 eyes in R and E group, respectively, and pupillary block was observed only in R group (4 eyes). There were no eyes that developed primary graft failure.

Conclusions : While DSAEK performed by residents produced high graft clarity rate, visual outcome and endothelial cell density were worse compared with those performed by an experienced surgeon. Proper management of early postoperative complications seemed to be a key to success for inexperienced surgeons.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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