Graft Rejection Following Descemet Stripping Automated Endothelial Keratoplasty: Features, Risk Factors, and Outcomes

Wu, Elaine; Ritterband, David C.; Yu, Guo‐Pei; Shields, Rebecca A.; Seedor, John A.

doi:10.1016/j.ajo.2011.10.004

Cited by 90 publications

(80 citation statements)

References 30 publications

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“…The frequency of graft rejection after PK was comparable with the 18% reported in patients with bullous keratopathy by the Swedish Corneal Transplant Registry (Claesson et al 2002). In other studies of DSAEK (Allan et al 2007;Anshu et al 2012;Wu et al 2012), including both FED and secondary endothelial failure, 7.5% to 9% of patients experienced graft rejection during the first 2 years after surgery. In this study, significantly more graft failures occurred after DSAEK than after PK, when evaluating both high-risk and low-risk eyes.…”

Section: Discussionsupporting

confidence: 65%

“…Preparation, insertion and manipulation of the posterior lamellar transplant possibly increase the probability of endothelial cell loss after DSAEK, which may induce primary failure, or endothelial decompensation over time (Price et al 2010;Yoeruek et al 2014). Several previous studies have described and compared the risk of graft rejection and failure after DSAEK and PK (Beckingsale et al 2006;Allan et al 2007;Price et al 2009;Anshu et al 2012;Wu et al 2012;Hjortdal et al 2013). However, most of these studies have indiscriminately included patients with primary endothelial failure due to Fuchs endothelial dystrophy and secondary endothelial failure as a complication to other eye diseases and surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

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Graft rejection and failure following endothelial keratoplasty (DSAEK) and penetrating keratoplasty for secondary endothelial failure

Pedersen

Ivarsen

Hjortdal

2014

Acta Ophthalmologica

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ABSTRACT.Purpose: To compare the frequency of rejection and graft failure after Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) for secondary endothelial failure. Methods: Seventy-eight eyes undergoing DSAEK from 2006 to 2013 and 80 eyes undergoing PK from 1998 to 2013 were included. Indications were endothelial failure due to pseudophakic bullous keratopathy (82%), previous eye trauma (8%), uveitis (4%) or other causes (6%). Rejection episodes and graft failure were recorded, together with preoperative risk factors (glaucoma, neovascularization and active inflammation). Kaplan-Meier survival curves with up to 4 years follow-up were used to compare DSAEK with PK, as well as low-risk with high-risk eyes. Results: During follow-up, 15% of the PK-treated eyes and 4% of the DSAEKtreated eyes experienced rejection. Graft failure occurred in 8% of the PKtreated eyes and in 7% of the DSAEK-treated eyes. No significant differences were found in the rate of rejection (p = 0.11), graft failure (p = 0.29) or rejection-related graft failure (p = 0.30) between DSAEK and PK in low-risk eyes. In DSAEK, high-risk eyes (mainly with glaucoma) experienced significantly more rejection episodes (p = 0.01), graft failures (p = 0.04) and rejectionrelated graft failures (p = 0.04) compared with low-risk eyes. No differences were seen between high-risk and low-risk PK-treated eyes (p > 0.40). Conclusion: In the present, relatively small study, no differences in rejection rate or graft failure were found between DSAEK and PK in low-risk eyes. However, glaucoma seems to increase the risk of graft complications after DSAEK for secondary endothelial failure. Long-term studies of larger samples sizes are needed to confirm this.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Graft rejection and failure following endothelial keratoplasty (DSAEK) and penetrating keratoplasty for secondary endothelial failure

Pedersen

Ivarsen

Hjortdal

2014

Acta Ophthalmologica

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“…A gama de achados clínicos indicativos de rejeição difere em alguns aspectos entre DSEK e ceratoplastia pe netrante, sendo que a maior parte dos olhos de rejeição no DSEK tende a ser assintomático e muitas vezes relacionado à interrupção do uso de corticoides tópicos (8,9) . Na nossa amostra foi observada a taxa de 12,3% e 14,8% no grupo DSEK e PHACO-DSEK, respectivamente, valor dentro da média quando comparada às publicadas mundialmente (0%-45%) (4) .…”

Section: Discussionunclassified

“…Doenças de eleição para estes procedimentos são a distrofia de Fuchs, ceratopatias bolhosas, síndrome endotelial iridocorneal ou falência de transplante penetrante (6) . Nos últimos anos, complicações relacionadas ao procedimento foram descritas na literatura (7)(8)(9)(10)(11)(12)(13) . DSEK fornece mais rápida reabilitação visual e um perfil de segurança aprimorada em comparação com o padrão da ceratoplastia penetrante, principalmente no que diz respeito à ferida operatória e complicações relacionadas à sutura, além do risco menor de hemorragia transoperatória (7) .…”

Section: Complicações Em Ceratoplastia Endotelial Com Desnudamento Daunclassified

Complicações em ceratoplastia endotelial com desnudamento da Descemet (DSEK)

Moura¹,

Oliveira²,

Tognon³

et al. 2013

Arq. Bras. Oftalmol.

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INTRODUÇÃOO transplante endotelial foi descrito inicialmente em modelo animal em 1993 por Ko et al.(1) e mais tarde, em 1998, Melles et al.publicaram o primeiro transplante endotelial em humanos. Em 1999, iniciaram-se os estudos com a ceratoplastia endotelial lamelar profunda (DLEK, do inglês, "deep lamellar endothelial keratoplasty"), que consiste na retirada de lamela posterior do receptor, com a inserção do botão doador e colocação na bolsa criada anteriormente (3) . A técnica de ceratoplastia endotelial por desnudamento endotelial (DSEK, do inglês, "Descemet stripping endothelial keratoplasty") foi concebida em 2005 (4) , Nessa técnica é realizada a retirada da membrana de Descemet do receptor, com subsequente inserção RESUMO Objetivo: Descrever a taxa de complicações e os tipos de complicações intraoperatórias e pós-operatórias da ceratoplastia endotelial com desnudamento da Descemet (DSEK (46,2%). A cirurgia mais comumente realizada foi o transplante endotelial isoladamente (DSEK), realizado em 65 olhos (54,6%), seguida do DSEK associado à facoemulsificação de cristalino (PHACO-DSEK) em 47 olhos (39,5%) e DSEK associado a outras cirurgias (7 olhos, 5,9%). Oito pacientes foram excluídos do trabalho devido informações cirúrgicas insuficientes em prontuário médico. Em relação às complicações cirúrgicas transoperatórias, foram observados casos isolados de bloqueio pupilar, dissecção irregular do botão, implante reverso do botão, "button-holing" e ruptura de cápsula posterior. Entre as complicações precoces, observou-se descolamento de botão em 21,5% dos olhos no grupo do DSEK, 34,0% no grupo PHACO-DSEK e 57,1% no grupo DSEK associado a outras técnicas cirúrgicas. No que se refere às complicações tardias, observou-se "haze" (opacidade) em interface em 16,9%, 8,5% e 14,2% e glaucoma foi observado em 4,6%, 2,1% e 14,2% dos olhos nos grupos DSEK, PHACO-DSEK e DSEK associado a outras técnicas, respectivamente. Falência pós-rejeição foi observada em 15,3% e 12,7% dos grupos DSEK e PHACO-DSEK, respectivamente. Conclusão: O transplante endotelial de córnea realizado nesta amostra teve uma taxa de complicações considerada alta se comparado aos transplantes penetrantes convencionais. As complicações mais frequentes foram aquelas relacionadas ao descolamento de botão e à falência pós-rejeição. Descritores

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“…Nach einer DSAEK-Operation, bei welcher Endothel, Descemet und Stromaanteile transplantiert werden, ist das Risiko einer immunologischen Abstoßungsreaktion mit etwa 7-15 % auf 2 Jahre etwa gleich hoch oder nur leicht geringer als bei einer PKP, die für vergleichbare Indikationen durchgeführt wird (Fuchs-Dystrophie, pseudophak-bullöse Keratopathie). Das Risiko für eine Abstoßung bei diesen Patienten ist somit deutlich höher als für eine PKP bei Keratokonus [11,12].…”

Section: Introductionunclassified

Komplikationen der Descemet Stripping Automatisierten Endothelkeratoplastik (DSAEK)

et al. 2015

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The most important preoperative complication is a delayed indication for the operation. In contrast to PK, DSAEK and DMEK surgery should be provided at an earlier stage of disease as chronic edema alters the stroma and reduces the speed of visual recovery. The most important complications during or early after surgery are detached lamellae, pupillary blocks with increased pressure or air bubbles in the vitreous cavity in patients with previous vitrectomy. The main long-term complications include chronic increased intraocular pressure and immune-mediated graft rejections in DSAEK patients after reducing or stopping topical corticosteroid therapy. This article describes the potential complications of endothelial keratoplasty and provides a detailed explanation of strategies to avoid these complications.

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Graft Rejection Following Descemet Stripping Automated Endothelial Keratoplasty: Features, Risk Factors, and Outcomes

Cited by 90 publications

References 30 publications

Graft rejection and failure following endothelial keratoplasty (DSAEK) and penetrating keratoplasty for secondary endothelial failure

Graft rejection and failure following endothelial keratoplasty (DSAEK) and penetrating keratoplasty for secondary endothelial failure

Complicações em ceratoplastia endotelial com desnudamento da Descemet (DSEK)

Komplikationen der Descemet Stripping Automatisierten Endothelkeratoplastik (DSAEK)

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