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Lauren Hock, Yi Jiang, Vanee Virasch, Jonathan Rubenstein; Outcomes of Resident Descemet’s Stripping Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1213.
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© ARVO (1962-2015); The Authors (2016-present)
To report the indications, complications, and visual outcomes of Descemet’s stripping endothelial keratoplasty (DSEK) performed at a single center resident clinic and compare these measures to those reported in the literature.
We performed a retrospective chart review of 37 patients, 53 eyes who underwent primarily senior resident-performed DSEK at our institution from 2007 to 2014. Clinical information including demographics, past ocular history, surgical indication, best pre-operative best corrected visual acuity (BCVA), applanation pressures, diagnosis, intraoperative and postoperative complications, final graft clarity, and BCVA at 1, 3, 6, and 12 month follow up visits was recorded. We excluded all patients with less than 6 months of follow up, prior history of penetrating keratoplasty, and pediatric patients under 18 years old.
Fifty-three eyes of 37 patients underwent primarily resident-performed DSEK. 62.3% of patients were female. Mean age was 68.2 years (range, 42-87). Mean length of follow up was 37.5 months (6-96). 13.2% of procedures were performed for indication of Fuchs corneal dystrophy, 52.8% for Fuchs with cataract, and 28.3% for bullous keratopathy.At final follow-up visit 60.4% of all cases, 79.5% of those with no prior ocular history, and 82.4% of cases indicated for Fuchs or Fuchs with cataract achieved 20/40 BCVA or better. At six months 44.7% of all cases, 57.6% (n=19) of cases in patients with no prior ocular history, and 62.1% (n=18) with Fuchs, achieved 20/40 or better. Patients with an indication of Fuchs or Fuchs and cataract had significantly better mean final BCVA than patients without a Fuchs indication (p<0.05). Patients with no prior ocular history had significantly better mean final BCVA (p<0.05).The most common postoperative complication was IOP elevation >30 mmHg (28.3%). 11 (20.8%) cases were complicated by lenticular detachment, 8 (15.1%) by graft rejection, and 10 (18.9%) by graft failure. History of glaucoma was significantly predictive of graft failure.
Our study achieved similar visual outcomes (final BCVA of 20/40 or better) to those reported in the literature for beginning surgeons. Higher rates of lenticular detachments reported here are consistent with other smaller case series and may be related to novice surgeons’ necessary learning curve. Other complication rates were close to other studies with similarly small sample sizes in the literature.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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