Purchase this article with an account.
Gioconda J. Mojica, Lissa Padnick-Silver, Marian S. Macsai-Kaplan; The Incidence of Primary Iatrogenic Graft Failure in DSEK. Invest. Ophthalmol. Vis. Sci. 2011;52(14):764.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate and understand primary graft failure in DSEK
De-identified data were collected retrospectively from the Illinois Eye Bank’s Midwire system. Presumed iatrogenic graft failure (PIGF) was defined as cases in which a repeat corneal transplant was performed <8 weeks following an initial DSEK. Data collected for each case included coded patient number, time (in days) between initial DSEK and re-graft, diagnosis, surgeon name, recipient age, donor age, re-graft type (DSEK v. PK), pre-cut vs. surgeon-cut tissue, and number of DSEK tissues distributed by the eye bank to individual surgeons. All surgeries were performed between April 2007 and May 2010. A total of 93 cases of PIGF were identified for a group of 50 surgeons. Cases from surgeons in cornea fellowships were identified. Individual surgeon and overall DSEK failure rate was calculated. Analysis of overall failure rate was conducted both with and without cases performed by attending surgeons who train fellows. Effect of surgical experience on PIGF was analyzed.
Overall PIGF rate in cases including and excluding fellows was 3.49% and 3.42% respectively. Average time between initial DSEK and re-graft was 27.5 days.Initial diagnoses included: Fuch’s, PBK, keratoconus, edema, and other disease states. Average recipient age was 71.7 years. Average donor age was 55 years. Age of recipient and donor did not influence graft failure rates. Pre-cut vs. surgeon-cut tissue did not affect overall graft failure rates. Failure rates of less experienced surgeons were higher than more experienced surgeons.
Overall, DSEK has a low failure rate, particularly with very experienced surgeons. Underlying pathology, recipient and donor age, and pre-cut v. surgeon-cut tissue did not affect procedural failure rates.
This PDF is available to Subscribers Only