Abstract
Purpose :
To determine the efficacy of radial full-thickness fixation sutures in DSEK among patients considered at high risk for graft dislocation.
Methods :
A retrospective chart review was performed to identify patients who underwent DSEK at Mayo Clinic between January 2015 and January 2021. Cases at high risk of graft dislocation were defined as eyes that had prior trabeculectomy, glaucoma drainage devices, absence of lens capsule, vitrectomy, or penetrating keratoplasty. The primary outcome was graft dislocation rate (defined as the need for rebubble) among eyes that had graft fixation with four radial full-thickness 11-0 nylon sutures versus no fixation sutures.
Results :
Three hundred fifty-seven DSEK surgeries occurring among 323 eyes of 242 patients were reviewed, and 181 were considered high risk. Of the high risk cases, 66 had graft suture fixation and 115 were unsutured. Baseline demographics and ocular comorbidities were comparable. Sutured DSEKs had a graft dislocation rate of 5% (n=3), versus 14% (n=16) of unsutured grafts (p<0.05). In the sutured group, one case of dislocation also had primary graft failure which may have contributed to failure to attach.
Conclusions :
DSEK is a useful graft procedure for patients with corneal endothelial failure and complicated anatomy. We showed that intraoperative suture fixation of the graft reduces graft dislocation rates in these high-risk eyes.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.