Endothelial keratoplasty in failed grafts

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Presentation transcript:

Endothelial keratoplasty in failed grafts Pravin K Vaddavalli Cornea & Refractive surgery Service LV Prasad Eye Institute Hyderabad, India The authors have no financial interests to disclose

Endothelial keratoplasty evolution Descemets Membrane Endothelial Keratoplasty (DMEK) Posterior Lamaellar keratoplasty (PLK) Deep Lamellar Endothelial Keratoplasty (DLEK) Descemet’s Stripping Endothelail Keratoplasty (DSEK) Descemets Stripping Automated Endothelial Keratoplasty (DSAEK)

Indications Fuchs’ endothelial dystrophy Pseudophakic and Aphakic corneal edema Endothelial decompensation Failed grafts ICE syndrome Unsalvageable Descemet’s membrane detachment TASS Corneal trauma Bee sting Birth trauma PPMD/ CHED Terry MA, Shamie N, Chen ES, Hoar KL, Friend DJ Endothelial keratoplasty a simplified technique to minimize graft dislocation, iatrogenic graft failure, and pupillary block. Ophthalmology. 2008 Jul;115(7):1179-86 Bahar I, Kaiserman I, Buys Y, Rootman D Descemet's stripping with endothelial keratoplasty in iridocorneal endothelial syndrome. Ophthalmic Surg Lasers Imaging. 2008 Jan-Feb;39(1):54-6

Indications for endothelial keratoplasty in our first 100 cases Relatively poor outcomes for DSAEK following failed grafts Covert DJ, Koenig SB. Descemet stripping and automated endothelial keratoplasty (DSAEK) in eyes with failed penetrating keratoplasty. Cornea. 2007 Jul;26(6):692-6t

Purpose Evaluate the outcomes of Descemets stripping endothelial keratoplasty (DSEK) in eyes with failed grafts Design Retrospective analysis of all cases of failed grafts undergoing DSEK in a tertiary eye hospital

Methods Retrospective case analysis First 100 consecutive cases of DSEK by single surgeon (PKV) All patients with failed grafts undergoing DSEK Variables Demographic data Improvement of best corrected visual acuity Endothelial cell density Complications

Indications for penetrating keratoplasty Results Indications for penetrating keratoplasty M:F :: 14:8 Mean age 30.8 ± 19 yrs (7 - 81 yrs) Indication for PK – Infection, CHED Lens status Pseudophakic Aphakic Phakic 9 1 12

Results Mean follow up - 6.13 months (1 month – 12 months) Endothelial cell density: 38.3% endothelial cell loss at 1 month Donor 1 month 3 months 6 months 12 months 2939 1808 1660 1553 1488

Results Best corrected visual acuity (logMAR) improvement from pre op values clinically significant (8 subjects showed improvement in BCVA of 2 lines or more on Snellen charts) p = 0.45

Complications Complications n Lenticule dislocation 1 Primary graft failure Complications n Lenticule dislocation 1 Primary graft failure 2 Allograft rejection Secondary glaucoma 3 Interface scarring Lenticule folds Allograft rejection Interface scarring Lenticule folds

Results Graft survival: DSEK in failed grafts – 60% Graft survival: DSEK in other indications – 91%

Conclusions Endothelial keratoplasty in failed grafts good option Endothelial cell loss mimics that for other indications Clinically significant visual improvement Allograft rejection and primary failure more common Graft survival significantly lower than for other indications