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G. O. Rosenwasser, D. Lu, D. Friend; Predictive Factors for Donor Disk Dislocation After DSAEK and the Effect of Donor Disk Dislocation on Endothelial Survival. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1615.
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To analyze predictive factors for donor disk dislocation the effect of donor disk dislocation on endothelial cell density after DSAEK.
One surgeon performed DSAEK surgery on 412 eyes using a corneal insertion shovel with up to 24 months of follow-up. Data was prospectively collected pre-op, and post-op at 6, 12, 18, and 24 months. Patients included 204 PCIOL’s and 27 ACIOL’s. DSAEK under PKP was done in 20 cases. A logistic regression was performed to determine which pre-operative variables are predictive of a dislocation event. Variables entered as potential predictors were: patient age, diagnosis for transplant, presence of an ACIOL or PCIOL, previous glaucoma surgery, concurrent vitrectomy, concurrent phaco, graft size, incision size, death to surgery time (in days), donor ECD and donor age. ANOVA analysis with Scheffe’s LSD post hoc analysis was used to compare endothelial cell loss at three time gates (6 months, 12 months and 24 months).
Donor dislocation required single re-bubbling in 86 eyes (21%) and multiple rebubblings in 18 eyes. The overall regression model formed was not predictive of dislocation (p=.138). Endothelial cell loss was 31 and 40% for no dislocation events, 30 and 45% for single dislocations, and 47 and 57% loss for multiple dislocations at 1 and 2 years respectively. The difference in cell loss at one year was significantly different (p=.047).
This large, prospective study shows that none of the predictive factors analyzed were predictive of donor disk dislocation. Single and multiple disk dislocations had a significant effect on the loss of endothelial cells in DSAEK using the donor shovel insertion technique.
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