Outcomes of complex Descemet’s Stripping Endothelial Keratoplasty

Abstract

Purpose : To investigate whether additional procedures performed concurrently with Descemet’s stripping endothelial keratoplasty (DSEK) affect the clinical outcomes.

Methods : A retrospective review of 495 DSEK procedures of 390 patients performed by two surgeons (AJA and SXD) from May 2006 to January 2015 at a single institution and had a minimal follow up for 6 months. The type and number of co-procedures, postoperative corrected distance visual acuity, and postoperative complications including donor detachment, graft rejection, primary and secondary graft failure, and elevation of intraocular pressure (IOP, ≥ 25 mmHg) were reviewed.

Results : Two hundred and ninety-four of 495 DSEK procedures (59.4%) were performed alone. One hundred fifty-nine (32.1%) and 42 (8.49%) DSEK were performed with 1 and 2 co-procedures, respectively. The commonly performed co-procedures were cataract extraction with IOL implantation (116 eyes; 23.4%), anterior vitrectomy (50 eyes; 10.1%), IOL exchange or secondary IOL implantation or IOL repositioning (30 eyes; 6.1%), tube trimming (25 eyes; 5.0%), and lysis of iridocorneal adhesion or retrocorneal membrane removal (24 eyes; 4.9%). The overall incidence of postoperative corrected distance visual acuity improvement was 84.1%. The rate of postoperative IOP elevation, graft detachment, graft rejection, secondary graft failure, and primary graft failure were 20.6%, 14.7%, 7.7%, 7.5%, and 3.0%, respectively. No statistically significant difference was found in the visual improvement and complications between DSEK procedures performed alone and those performed with co-procedures, except for the postoperative IOP elevation. DSEK performed with 2 co-procedures had a higher incidence of IOP elevation (38.1%) compared to DSEK performed alone (22.1%; p<0.05).

Conclusions : Complex DSEK performed with concurrent procedures can achieve a similar level of visual rehabilitation without a higher complication rate except postoperative IOP elevation.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.