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M. Giegengack, L. Rich, W. D. Mathers, R. W. Fraunfelder; Dsaek Experience Including Eyes With Altered Anterior Chamber Architecture. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4722.
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© ARVO (1962-2015); The Authors (2016-present)
To report outcomes and complications of all Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) performed at the Casey Eye Institute, Portland, OR.
Forty eyes of 39 patients underwent DSAEK at the Casey Eye Institute from 12/05-12/06. Initial diagnosis and pre-op BCVA was recorded for each patient. Complications secondary to the surgery were noted. BCVA at 1 month and 3 months were obtained when available. Snellen visual acuities were converted to logMAR for statistical purposes. Mean visual acuities were reconverted to Snellen for discussion purposes.
Preoperative diagnoses included Fuchs dystrophy (21 eyes), Pseudophakic bullous keratopahty (9 eyes), Failed penetrating keratoplasty grafts (7 eyes), and other forms of bullous keratopathy (3 eyes). BCVA pre-op averaged 20/200 (20/40-LP). Potential complicating factors included ACIOLs (4), trabeculectomies (trab) (8), Ahmed valves (2), and a scleral buckle.Eleven of 40 eyes (27.5%) had detachment of donor tissue requiring surgical repositioning. 3 eyes (8%) had transient pupillary block glaucoma secondary to the anterior chamber air bubble. One eye with ACIOL had donor dislocation. One eye with a trabeculectomy had donor dislocation. The eye with the scleral buckle had donor dislocation. All instances of dislocated tissue were successful repositioned. All data for visual outcome includes those cases complicated by dislocation.BCVA at 1 month averaged 20/100 (20/25-HM) with 29 % having BCVA of 20/40 or better. BCVA > 1 month (when available) averaged 20/50 (20/25-LP) with 67% 20/40 or better.
DSAEK is a promising surgical technique for the treatment of endothelial dysfunction. The complication of dislocated donor tissue is significant. Successful DSAEK procedures can be done on patients with altered anterior chamber architecture (trab, Ahmed, ACIOL, scleral buckle). Preliminary results from initial cases at the Casey Eye Institute demonstrate similar visual outcomes and complication rates as other published reports.
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