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P. Taravati, K. M. Goins; Outcomes Following Descemet’s Stripping Endothelial Keratoplasty (DSEK). Invest. Ophthalmol. Vis. Sci. 2008;49(13):2340.
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To determine the best-corrected visual acuity (BCVA) and corneal endothelial cell density (ECD) 1, 3, 6 and 12 months following Descemet’s stripping endothelial keratoplasty (DSEK). The incidence of postoperative pupillary block, lenticule dislocation, and secondary procedures was also examined.
A retrospective review was done of 97 eyes (89 patients) that underwent DSEK between August 2005 and November 2006 at the University of Iowa. Baseline data included age, BCVA, and diagnosis. Outcome measures were recorded at 1, 3, 6, and 12 months postoperatively. ECD was measured predominantly using non-contact specular microscopy, when permitted by corneal clarity.
The mean age at surgery was 71 + 11 years. Preoperatively, the mean best-corrected visual acuity was 0.7 logMAR + 0.6 logMAR, and the mean donor ECD was 3007 + 299 cells/mm2. Of the 97 eyes, 64 had Fuchs’ endothelial dystrophy, 24 had pseudophakic bullous keratopathy, 1 had bullous keratopathy, 6 had failed penetrating keratoplasty grafts, 1 had a failed DSEK graft, and 1 had Fuchs’ endothelial dystrophy with anterior stromal fibrosis. Fifty-four eyes underwent DSEK only, 37 underwent combined phacoemulsification and DSEK, 3 underwent DSEK and anterior vitrectomy, 1 underwent DSEK and synechiolysis, 1 underwent DSEK and superficial keratectomy, and 1 underwent DSEK and Ahmed shunt revision. The incidence of postoperative pupillary block was 20%. One patient developed aqueous misdirection requiring pars plana vitrectomy and peripheral iridectomy. The incidence of lenticule dislocation was 25%, all requiring lenticule repositioning and air tamponade. The incidence of iatrogenic graft failure was 3% and allograft rejection 1%, all requiring repeat DSEK. Mean postoperative BCVA was 0.5 logMAR + 0.5 logMAR (n=93) at 1 month, 0.3 logMAR + 0.3 logMAR (n=82) at 3 months, 0.3 logMAR + 0.3 logMAR (n=76) at 6 months, and 0.3 logMAR + 0.4 logMAR (n=53) at 12 months. The mean postoperative ECD was 1973 + 648 cells/mm2 (n=29) at 1 month, 2083 + 601 (n=41) cells/mm2 at 3 months, 1939 + 539 cells/mm2 (n=20) at 6 months, and 1575 cells/mm2 + 624 cells/mm2 (n=29) at 12 months.
DSEK provides rapid visual rehabilitation and excellent BCVA in patients with endothelial dysfunction. Despite leaving just enough air in the anterior segment to cover the disc edges, there was a high rate of postoperative pupillary block and lenticule dislocation in this series. These findings confirm the necessity of multiple postoperative examinations immediately after DSEK in order to diagnose and treat complications.
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