1. Descemet Stripping Automated Endothelial Keratoplasty in patients with Toxic anterior segment syndrome induced endothelial failure First and Presenting author: Jeewan S. Titiyal Co-authors: Tarun Arora, Manpreet Kaur, Tushar Agarwal Affiliation: RP Centre, AIIMS, New Delhi, India None of the authors of this poster have any financial interests

2. Purpose To evaluate the factors responsible for success and failure of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in patients with Toxic anterior segment syndrome (TASS) induced endothelial failure

3. Methodology Type of study: Retrospective case series Number of cases = 5 Inclusion criteria: Patients with endothelial failure as a result of TASS, post phacoemulsification surgery and IOP ≤ 24 mm Hg with or without medications

4. Parameters Evaluated Demographic profile Preoperative Endothelial count, Central corneal thickness (CCT), Intraocular pressure (IOP) Time interval of DSAEK surgery from onset of TASS Intraoperative challenges and complications during DSAEK surgery

5. Outcome measures (at final visit) Best-corrected visual acuity Intraocular pressure Graft clarity Donor and host corneal thickness Specular count

6. Results Mean (±SD) age was 58.6 (±4.04) years Mean (±SD) preoperative CCT was 615.4 (±46.8) microns Mean(±SD) preoperative specular count was 433.4(±40.6) cells/mm 2

7. Results (contd.) Mean (±SD) follow up was 15.3 (±5.2) months (range 6 – 24 months) At final follow up o Three cases (60%) maintained clear graft with BCVA ≥ 20/40, mean (±SD) host thickness: 414.3 ± 25.1 microns, mean (±SD) donor thickness: 140.2 ± 21.1 microns o Two cases had graft failure with BCVA 24m Hg)

8. Results (contd.) Average time interval between episode of TASS and successful DSAEK surgeries: 126.7 days Average time interval between episode of TASS and failed DSAEK surgeries: 31 days

9. Patient details Seri al No. AgeSexTime Interval between TASS and DSAEK Graft Clarity BCDV A IOPComplications 154M270PL+28Floppy iris, secondary glaucoma 262M350PL+30Increased anterior chamber inflammation, secondary glaucoma 355F120420/3020 - 459F128420/3016 - 563M132320/4018 -

10. Results (contd.) Possible factors for graft failure Floppy iris leading to extensive peripheral anterior synechiae, Postoperative exacerbated inflammation, pigment release and Increased intraocular pressure

11. Conclusion Early DSAEK surgery in patients with endothelial failure as a result of TASS are associated with increased postoperative inflammation and raised IOP which may eventually lead to poor outcome of DSAEK surgery

12. Conclusion Delayed DSAEK surgery after proper control of inflammation and intraocular pressure leads to excellent outcomes in cases with endothelial failure due to Toxic anterior segment syndrome