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

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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 
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