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D. W. DelMonte, T. Kim, N. Afshari, A. Carlson; Risk Factors for Complete Donor Tissue Dislocation after Descemet Stripping Endothelial Keratoplasty (DSEK). Invest. Ophthalmol. Vis. Sci. 2009;50(13):1238.
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To find risk factors leading to complete donor tissue dislocation after DSEK.
A retrospective review of the first consecutive 300 DSEK patients at the Duke University Eye Center by three cornea surgeons was performed as a comparative case-control study. Cases were defined as those eyes where the DSEK procedure resulted in complete dislocation of the donor tissue and needed repeat DSEK or PK. Controls were defined as eyes where the DSEK procedure was successful in attaching the donor tissue, including eyes where post-operative air injections were needed to treat partial dislocations. Repeat surgeries were counted as a separate procedure.
Dislocations needing repeat DSEK or PK occurred in 5% (13) of eyes. Insignificant differences between cases and controls included: 1) patient and donor tissue characteristics, 2) prior glaucoma surgeries (except tube shunts), prior PK, and DSEK in combination with other procedures, 3) use of precut donor tissue, and 4) pre-operative IOP. Statistically significant (P<0.05) differences between cases and controls included: 1) Donor tissue trauma (from tissue reinsertion, insertion through a 3mm incision, and eye rubbing); 2) Anterior chamber characteristics impacting surgical space (anterior synechea, shallow anterior chamber, tube shunts).
Based on our data it appears that poor patient selection, or an anterior chamber not amenable to DSEK, is a potential risk for complete dislocation. Donor tissue trauma from insertion and unfolding problems as well as post-operative eye rubbing increase the risk of complete donor tissue dislocation.
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