Purchase this article with an account.
Jun Shimazaki, Daisuke Tomida, Koji Kakisu, Takefumi Yamaguchi, Yoshiyuki Satake; Descemet Stripping and Automated Endothelial Keratoplasty Performed by Residents. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4782.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Surgical educations is an important issue in corneal transplantation. We have reported that outcomes of penetrating keratoplasty performed by residents were similar to those performed by an experienced surgeon (Shimmura-Tomita M, et al. J Surg Educ 2016). As Descemet stripping automated endothelial keratoplasty (DSAEK) becomes a leading surgical method for the treatment of bullous keratopathy (BK), surgical education for DSAEK attracts more attention. The purpose of the study is to compare the outcomes of DSAEK performed by residents with an experienced surgeon.
In this case control study, we analyzed outcomes of DSAEK performed by residents (R group. n=41) and by a single experienced surgeon (JS, E group, n=35). First 5 to 10 DSAEK cases performed by residents were analyzed. The residents had experiences for penetrating keratoplasty, and the surgery was performed under guidance with experienced surgeons. Graft clarity rate, incidence of postoperative complications, visual acuity, surgical time, and % endothelial cell loss at 1, 3, 6, and 12 months following surgery were studied.
Both groups had similar preoperative status including age (P=0.94) and visual acuity (P=0.10). The leading causes for BK included laser iridotomy-induced BK and pseudophakic BK. Surgical time was significantly longer in R group compared with E group (67.6 vs. 49.2 minutes, P=0.0013) At 12 months, graft clarity was maintained in 100% and 97.1% of cases in R and E groups, respectively. Three and one eyes in the R and E groups, respectively, later developed endothelial decompensation. Mean corrected visual acuity was significantly better in E group compared with that in R group at 6 (P=0.031) and 12 months (P=0.0044) postoperatively. Mean corneal endothelial cells loss at 12 months was 56.5±18.9 % and 44.0±24.5% in R and E groups, respectively (P=0.077). Postoperative double chamber/graft dislocation was observed in 6 and 4 eyes in R and E group, respectively, and pupillary block was observed only in R group (4 eyes). There were no eyes that developed primary graft failure.
While DSAEK performed by residents produced high graft clarity rate, visual outcome and endothelial cell density were worse compared with those performed by an experienced surgeon. Proper management of early postoperative complications seemed to be a key to success for inexperienced surgeons.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only