Amit Patel, FRCOphth Massimo Busin, MD

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Presentation transcript:

Descemet Stripping Endothelial Keratoplasty (DSAEK) Following Penetrating Keratoplasty (PK) Amit Patel, FRCOphth Massimo Busin, MD Villa Serena Hospital, Forli’, Italy Fondazione Banca degli Occhi del Veneto, Venice, Italy ------------------------------------------------------------------------------------------------------------ Financial Disclosure Pfizer (UK) Ophthalmic Fellowship Award (AP) Travel reimbursements and royalties from Moria, Antony, France (MB)

PURPOSE To Evaluate the Outcomes of DSAEK in Eyes With Post-Penetrating Keratoplasty (PK) Endothelial Decompensation.

METHODS Prospective Study Cause of Endothelial Failure January 2007 to June 2009 Cause of Endothelial Failure UCVA, BCVA, ECC noted at 1, 3, 6, 12 and 24 months post-DSAEK Complications

SURGICAL TECHNIQUE Descemetorhexis Within PK wound and Peripheral Iridotomy Graft Delivery with Busin Glide Through a 3.2mm Clear-Corneal Tunnel

SURGICAL TECHNIQUE 8.5 to 9.0mm Donor Button(arrows) Centered on the Limbus Regardless of the PK Wound Air Fill to Achieve Graft Attachment & Air-tight Suturing of All Wounds

RESULTS 31 Cases Recruited 29/31 Immunologic Graft Failure All DSAEK Grafts Larger than Original PK(8.5-9.0 mm vs 7.5-8.0 mm)

RESULTS All Grafts Attached (1 case Required Re-bubbling) Average Follow up 9.8 Months (Range 3-24 Months) ECL at 1 year = 27.5% [16/31 eyes] No Graft Failures at Last Follow up

RESULTS Visual Outcomes Pre-op BCVA <20/200 in 30/31 cases Post-op BCVA Improved in 25/31 cases Unchanged in 6/31 cases

RESULTS Complications 1 Graft Detachment on 1st Postoperative Day (Successful Attachment with Re-bubbling) 1 PK Wound Dehiscence (sutured ) 1 Immunologic Graft Rejection (Treated Successfully)

CONCLUSIONS DSAEK is Effective in Treating Post PK Endothelial Failure 2-Year Success Rate is High in Eyes with High Risk of Rejection in spite of a Diameter Larger than that of the Original PK