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Darrell Robert Lewis, Rosalind M.K. Stewart, Elsie Chan; Quantifying risk factors for Descemet Stripping Automated Endothelial Keratoplasty dislocation. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1303. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Although risk factors for Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) graft dislocation have been suggested in the literature, few have been quantified. We performed a retrospective clinical study of DSAEK indications, operative techniques, and postoperative manoeuvres to identify and quantify associations with graft dislocation.
We retrospectively analysed DSAEK data from January 2012 to October 2017 identifying 357 cases. Surgeries were completed at a large tertiary Ophthalmic institution by 15 Cornea and External Disease specialists. Sufficient variation in surgical technique allowed for modelling of associations. Statistically significant predictors of DSAEK dislocation were identified and quantified through Ordinal Logistic Regression.
DSAEK dislocation requiring reinjection of filtered air was identified in 41 (11.5%) of cases. Wound leak was identified as the strongest association with DSAEK graft dislocation (OR=102.5; 95% CI=8.0-1307.3; p=<0.001), along with the inability of the patient to maintain supine posturing postoperatively (OR=9.2; 95% CI=1.2-68.7; p=0.031), and the creation of full thickness corneal venting incisions (OR=3.1; 95% CI=1.3-7.6; p=0.011). Female gender was found to have a protective effect (OR=0.42; 95% CI=0.2-1.0; p=0.049). While body mass index, indication for endothelial keratoplasty, prior trabeculectomy or tube shunt surgery, presence of an anterior chamber intraocular lens, graft insertion method, use of ophthalmic viscosurgical devices, and postoperative anterior chamber gas release, were not statistically significantly associated with graft dislocations.
The present study may help surgeons optimize their technique and minimize DSAEK graft dislocations. Wound leak, the inability of a patient to maintain supine posturing postoperatively, and full thickness corneal venting incisions were associated with DSAEK graft dislocation. Full thickness corneal venting incisions have previously been thought to be protective. Furthermore, the use of ophthalmic viscosurgical devices was not found to be associated with graft dislocation.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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