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

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

J Korean Ophthalmol Soc 2009;50(7):1115-1119.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.7.1115

Eight Cases of Descemet's Stripping Automated Endothelial Keratoplasty in Eyes With Bullous Keratopathy

Hee Ok Jeong, MD, Hyun Soo Lee, MD, Kyung Sun Na, MD, Choun-Ki Joo, MD, PhD

Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Choun-Ki Joo, MD, PhD Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea #505 Banpo-dong, Seocho-gu, Seoul 137-040, Korea Tel: 82-2-2258-7620, Fax: 82-2-533-3801, E-mail: ckjoo@catholic.ac.kr

Received 13 January 2009       Accepted 14 April 2009

Copyright © 2009 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Bullous keratoplasty, Descemet-stripping automated endothelial keratoplasty, Graft failure

References

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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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