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April Junene McCullough, Gerald W Zaidman; Outcomes of Descemet's Stripping Endothelial Keratoplasty in Vitrectomized Eyes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):893.
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© ARVO (1962-2015); The Authors (2016-present)
To report the incidence of intra- and postoperative complications and clinical outcomes of vitrectomized eyes undergoing Descemet's stripping endothelial keratoplasty (DSEK).
This was a retrospective review of vitrectomized eyes undergoing DSEK performed by one surgeon from 2008-2013. We analyzed intra- and postoperative complications, and outcomes such as graft clarity and final best-corrected visual acuity (BCVA).
15 eyes (13 patients) were analyzed. All eyes underwent mechanical anterior vitrectomy at the time of DSEK. 6 had also had a vitrectomy prior to DSEK. 11 eyes had pseudophakic and 4 had aphakic bullous keratopathy. 8 had BCVA from 20/50-20/200 and 7 had BCVA ≤ 20/400. For all eyes, Descemet's stripping was performed first, followed by anterior vitrectomy and lens insertion, then donor insertion via forceps with subsequent 100% air fill to achieve graft adherence. Air that migrated into the anterior vitreous wasn't removed. Immediately postoperatively, patients remained face-up for 1 hour with 100% air fill. Then they stayed flat for 24-48 hours. 14 eyes received a sulcus-sutured PCIOL and one underwent PCIOL repositioning. 8 eyes required multiple air bubble injections intraoperatively to achieve 100% air fill. There were no intraoperative complications. Follow-up time was 3-25 months. 4 eyes had graft detachment on the first postoperative day, with adherence achieved after one rebubbling in each case. One other eye had primary graft failure. This eye had a vitrectomy 15 years prior to DSEK; repeat DSEK 4 months later was successful. There were no cases of endothelial rejection. At the last postoperative visit, all eyes had clear grafts, 5 had BCVA ≥ 20/40, 6 had BCVA 20/50-20/200, and 4 had BCVA ≤ 20/400. Of the 5 eyes with graft detachment or primary failure, 3 had BCVA ≥ 20/40. For the 10 eyes that achieved graft clarity but not BCVA ≥ 20/40, the decreased vision was secondary to preexisting glaucoma or retinal pathology.
DSEK can be successful in vitrectomized eyes. We believe that the 75% non-rebubbling rate was due to our technique, which involved meticulous anterior vitrectomy, the presence of a well-positioned PCIOL prior to donor insertion, and our goal of a 100% air fill. However, despite successful surgery and 100% graft clarity, only 33% of eyes achieved BCVA ≥ 20/40. Visual prognosis is guarded because of preexisting pathology in these high-risk patients.
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