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