1. 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)

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

3. 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

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

5. 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

6. RESULTS 31 Cases Recruited 29/31 Immunologic Graft Failure
All DSAEK Grafts Larger than Original PK( mm vs mm)

7. 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

8. 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

9. 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)

10. 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