Journal List > J Korean Ophthalmol Soc > v.50(7) > 1008320

Jeong, Lee, Na, and Joo: Eight Cases of Descemet's Stripping Automated Endothelial Keratoplasty in Eyes With Bullous Keratopathy

Abstract

Purpose

To investigate the postoperative results of Descemet's stripping automated endothelial keratoplasty in bullous keratoplasty and graft failure cases.

Case summary

Eight eyes of eight patients who underwent DSAEK between September 2006 and August 2008 were followed-up for at least 3 months, and the charts of eight patients were reviewed retrospectively. Five eyes of the total eight had bullous keratopathy, and three eyes needed DSAEK due to graft failure. The best corrective visual acuity (logMAR) improved from 1.625±0.60 to 0.825±0.35 and corneal thickness decreased from 785.63±135.58 μ m to 692.00±150.85 μ m 3 months postoperatively. Grafted corneal dislocation occurred in two eyes, and we repositioned the cornea in those participants by air injection. We found graft rejection signs in two cases, and one case showed graft failure despite steroid therapy.

Conclusions

We think that DSAEK will be a good surgical procedure in bullous keratopathy or graft failure patients because of its favorable postoperative prognosis.

References

1. Thompson RW Jr, Price MO, Bowers PJ, Price FW Jr. Long-term graft survival after penetrating keratoplasty. Ophthalmology. 2003; 110:1396–402.
crossref
2. Ing JJ, Ing HH, Nelson LR, et al. Ten-year postoperative results of penetrating keratoplasty. Ophthalmology. 1998; 105:1855–65.
crossref
3. Boisjoly HM, Tourigny R, Bazin R, et al. Risk factors of corneal graft failure. Ophthalmology. 1993; 100:1728–35.
crossref
4. Al-Towerki AE, Gonnah el-S, Al-Rajhi A, Wagoner MD. Changing indications for corneal transplantation at the King Khaled Eye Specialist Hospital (1983–2002). Cornea. 2004; 23:584–8.
crossref
5. Al-Yousuf N, Mavrikakis I, Mavrikakis E, Daya SM. Penetrating keratoplasty: indications over a 10 year period. Br J Ophthalmol. 2004; 88:998–1001.
crossref
6. Kang PC, Klintworth GK, Kim T, et al. Trends in the indications for penetrating keratoplasty (1980–2001). Cornea. 2005; 24:801–3.
crossref
7. Melles GR, Eggink FA, Lander F, et al. A surgical technique for posterior lamellar keratoplasty. Cornea. 1998; 17:618–26.
crossref
8. Terry MA, Ousley PJ. Deep lamellar endothelial keratoplasty in the first United States patients: early clinical results. Cornea. 2001; 20:239–43.
9. Price FW Jr, Price MO. Descemet's stripping with endothelial keratoplasty in 50 eyes; a refractive neutral cornea transplant. J Refract Surg. 2005; 21:339–45.
10. Gorovoy MS. Descemet-stripping automated endothelial keratoplastyaccommodative. Cornea. 2006; 25:886–9.
11. Vincenzo S, Patricia T. Descemet-stripping automated endothelial keratoplasty by using suture for donor insertion. Cornea. 2008; 27:825–9.
12. Koenig SB, Covert DJ. Early results of small incision Descemet's stripping and automated endothelial keratoplasty. Ophthalmology. 2007; 114:221–6.
13. Koenig SB, Covert DJ, Dupps WJ Jr, Meisler DM. Visual acuity, refractive error, and endothelial cell density six months after DSAEK. Cornea. 2007; 26:670–4.
14. Price MO, Price FW Jr. DSEK: comparative outcomes with micro-keratome-dissected and manually dissected donor tissue. Ophthalmology. 2006; 113:1936–42.
15. Tan DT, Mehta JS. Future directions in lamellar corneal transplantation. Cornea. 2007; 26:S21–8.
crossref
16. Olson RJ. Air and the corneal endothelium: an in vivo specular microscopy study in cats. Arch Ophthalmol. 1980; 98:1283–4.
17. Koenig GB, Covert DJ. Early results of small-incision Descemet's stripping and automated endothelial keratoplasty. Ophthalmology. 2006; 114:221–6.
crossref
18. Seo WM, Kim HK. Early result of Femtosecond laser assisted Descemet's membrane stripping endothelial keratoplasty. J Korean Ophthalmol Soc. 2008; 49:40–7.
crossref
19. Cheng YY, Pels E, Nuijts RM. Femtosecond laser assisted Descemet's membrane stripping endothelial keratoplasty. J Cataract Refract Surg. 2007; 33:152–5.
20. Mehta JS, Por YM, Poh R, et al. Comparison of donor insertion techniques for DSAEK. Arch Ophthalmol. 2008; 126:1383–8.
21. Busin M, Bhatt PR, Scorcia V. A modified technique for DSAEK to minimize endothelial cell loss. Arch Ophthalmol. 2008; 126:1133–7.
22. Melles GR. Posterior lamellar keratoplasty: DLEK to DSEK to DMEK. Cornea. 2006; 25:879–81.

Figure 1.
Preoperative and postoperative photographs (Case 3): Graft dislocation. (A) Preoperative picture. (B) Picture which shows graft dislocation (Postoperative 10 days). (C) Picture after air injection and graft reposition (Postoperative 1 month).
jkos-50-1115f1.tif
Figure 2.
Preoperative and postoperative photographs (Case 2): Graft failure. (A) Preoperative picture. (B) Graft failure state (Postoperative 3 months).
jkos-50-1115f2.tif
Table 1.
Patients Characteristics
Group Case Age (yrs) Sex Pathology Preoperative BCVA* Preoperative corneal thickness (μm) Remarks
A 1 56 M BK§ 1.0 622
2 75 F BK 1.60 856
3 58 M BK 1.30 797
4 63 M BK 1.60 749
5 69 M BK 3.0 734 Glaucoma
B 6 69 M Graft failure after PKP 1.60 967 Glaucoma
7 59 M Graft failure after PKP 1.60 607
8 54 M Graft failure after DSAEK# 1.30 953
Mean 62.88±7.43 1.625±0.60 785.63±135.58

* BCVA=best corrected visual acuity

M=male

F=female

§ BK=bullous keratopathy

PKP=penetrating keratoplasty

# DSAEK= Descemet-stripping automated endothelial keratoplasty.

Table 2.
Characteristics of donor corneas
Group Case Recipient's pathology Donor age (yrs) Death to preservation time Donor corneal ECC* (/mm2)
A 1 BK 64 11 hrs 36 min 2974
2 BK 72 17 hrs 21 min 2521
3 BK 46 1 hr Unchecked
4 BK 61 2 hrs Unchecked
5 BK 54 11 hrs 44 min 2718
B 6 Graft failure after PKP 65 8 hrs 5 min 3024
7 Graft failure after PKP 64 11 hrs 36 min 2974
8 Graft failure after DSAEK§ 45 2 hrs 30 min 2475
Mean 58.88±9.63 442.50±383.12 min 2781.00±244.44

* ECC=endothelial cell count

BK=bullous keratopathy

PKP=penetrating keratoplasty

§ DSAEK=Descemet-stripping automated endothelial keratoplasty.

Table 3.
Postoperative complication and management
Group Case Postoperative Cx* Cx Management
A 1 At POD 3 months: Conservative care with steroid eyedrops
Transient stromal graft rejection
2 At POD 6 months: Conservative care with steroid eyedrops
Stromal graft rejection → Graft failure
3 Graft dislocation At POD 10 days:
Air injection and Reposition of DSAEK flap
4 Graft dislocation At POD 1 day:
Air injection and Reposition of DSAEK flap
5
B 6
7
8

* Cx=complication

POD=postoperative day.

Table 4.
Results of grafted corneas
Group Case Preop BCVA Postop BCVA* Preop corneal thickness (μm) Postop corneal thickness (μm) Donor corneal ECC (mm2) Postop grafted corneal ECC (/mm2)
A 1 1.0 0.7 622 715 2974 Uncheckable
2 1.6 1.6 856 977 2521 Uncheckable
3 1.3 0.5 797 466 Unchecked Uncheckable
4 1.6 0.5 749 608 Unchecked 2123
5 3 1.0 734 614 2718 Uncheckable
B 6 1.6 0.8 967 771 3024 Uncheckable
7 1.6 0.7 607 633 2974 1865
8 1.3 0.8 953 752 2475 Uncheckable
Mean 1.625±0.60 0.825±0.35 785.63±135.58 692.00±150.85 2781.00±244.44

* BCVA=best corrected visual acuity

ECC=endothelial cell count.

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