April 2009
Volume 50, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2009
Retrospective Review of Graft Dislocation Rate Associated With Descemet’s Stripping Endothelial Keratoplasty (DSEK) After Primary Failed Penetrating Keratoplasty (PKP)
J. Clements; C. Bouchard; W. B. Lee; S. P. Dunn; M. J. Mannis; J. Reidy; T. John; S. B. Hannush; K. M. Goins; M. Adi
Author Affiliations & Notes
  • J. Clements
    Ophthalmology, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois
    Ophthalmology, Loyola University Medical Center, Maywood, Illinois
  • C. Bouchard
    Ophthalmology, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois
    Ophthalmology, Loyola University Medical Center, Maywood, Illinois
  • W. B. Lee
    Ophthalmology, Eye Consultants of Atlanta/Piedmont Hospital, Atlanta, Georgia
  • S. P. Dunn
    Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan
  • M. J. Mannis
    Ophthalmology and Vision Science, University of California-Davis, Sacremento, California
  • J. Reidy
    Ophthalmology, University at Buffalo, Buffalo, New York
  • T. John
    Ophthalmology, Loyola University Medical Center, Maywood, Illinois
  • S. B. Hannush
    Ophthalmology, Wills Eye Institute, Philadelphia, Pennsylvania
  • K. M. Goins
    Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa
  • M. Adi
    Ophthalmology, Georgetown University Medical Center, Washington, Dist. of Columbia
  • Footnotes
    Commercial Relationships  J. Clements, None; C. Bouchard, None; W.B. Lee, None; S.P. Dunn, None; M.J. Mannis, None; J. Reidy, None; T. John, None; S.B. Hannush, None; K.M. Goins, None; M. Adi, None.
  • Footnotes
    Support  Richard A. Perritt Charitable Foundation
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 1237. doi:
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      J. Clements, C. Bouchard, W. B. Lee, S. P. Dunn, M. J. Mannis, J. Reidy, T. John, S. B. Hannush, K. M. Goins, M. Adi; Retrospective Review of Graft Dislocation Rate Associated With Descemet’s Stripping Endothelial Keratoplasty (DSEK) After Primary Failed Penetrating Keratoplasty (PKP). Invest. Ophthalmol. Vis. Sci. 2009;50(13):1237.

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Abstract

Purpose: : To report rate of graft dislocation in patients who underwent Descemet's Stripping Endothelial Keratoplasty (DSEK) after a previous Penetrating Keratoplasty (PKP).

Methods: : An institutional review board approved, multi-center, retrospective chart review was undertaken. Inclusion criteria included: prior PKP, failed PKP requiring re-transplantation secondary to endothelial cell failure and subsequent DSEK. The primary outcomes measured in this study were the presence of a graft dislocation, whether or not the dislocation required re-bubble and whether the graft ultimately attached. Additional variables measured included: prior glaucoma drainage device, graft-to-host size disparity, number of sutures remaining in PKP, and stripping of Descemet's membrane at the time of surgery.

Results: : 71 patients (74 eyes) were included in the study. Of those, 20/74 (27%) experienced a dislocation of the graft. All of these cases required re-bubble. However, 72/74 (97%) of those grafts ultimately remained attached for the duration of the follow up period. Only 2 eyes (2.7%) required PKP. There were 11 patients with a glaucoma drainage device present in the anterior chamber and 8/11 (73%) of these patients’ grafts dislocated, but ultimately attached. The dislocation rate for grafts larger than the host was 11/42 (27%), equal to host was 2/16 (13%) and smaller than host was 6/14 (43%). Dislocations occurred in 2/15 (13%) of grafts with sutures remaining and 18/59 (30%) of those with all sutures out. There were 5 cases of grafts without stripping Descemet's, there were no detachments in this group.

Conclusions: : Graft dislocation rates in uncomplicated DSEK is ~5% in the hands of experienced surgeons (>50 cases). The rate for the same experienced surgeons after a prior PKP was 27% in our study. Graft size smaller than host and patients with prior glaucoma drainage device are at increased risk.

Keywords: cornea: clinical science • transplantation 
© 2009, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Permission to republish any abstract or part of an abstract in any form must be obtained in writing from the ARVO Office prior to publication.
Copyright © 2015 Association for Research in Vision and Ophthalmology.
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