Management and Outcomes of Descemet Stripping Automated Endothelial Keratoplasty With Intraocular Lens Exchange, Aphakia, and Anterior Chamber Intraocular Lens

Hsu, Maylon; Jorgensen, Adam; Moshirfar, Majid; Mifflin, Mark D.

doi:10.1097/ico.0b013e31826ef43b

Cited by 31 publications

(21 citation statements)

References 29 publications

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“…Endothelial cell loss of about 19.6% 3 months after surgery from eye bank values is relatively low, and it compares favourably with the values reported after DSAEK and IOL exchange or even after uncomplicated DMEK procedure; but longer follow-up is needed 7 13 15…”

Section: Discussionsupporting

confidence: 67%

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Posterior iris-claw aphakic intraocular lens implantation and Descemet membrane endothelial keratoplasty

et al. 2014

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Section: Discussionsupporting

confidence: 67%

“…Hsu et al 15 reported a series of 30 complicated DSAEK eyes with a mean follow-up of 20.3 months. Of the 14 eyes who had undergone concurrent IOL exchange with DSAEK only one sulcus lens was placed.…”

Section: Discussionmentioning

confidence: 99%

Posterior iris-claw aphakic intraocular lens implantation and Descemet membrane endothelial keratoplasty

et al. 2014

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“…1-3 Post-operative dislocation of the donor endothelial graft remains one of the most common complications of DSAEK with a mean reported rate of 14% but with large variation between studies. 1,2,4-8 Recipient factors including previous incisional glaucoma surgery, 9,10,11 previous penetrating keratoplasty, 12 aphakia, 13,14 prior vitrectomy, 15 and the presence of an anterior chamber intraocular lens 16 have been shown to increase the rate of donor dislocation. Treatment of graft dislocation often requires a rebubble procedure, in which sterile air is injected into the anterior chamber to promote graft adherence, 7 which may increase the risk of endothelial failure.…”

Section: Introductionmentioning

confidence: 99%

Influence of Preoperative Donor Tissue Characteristics on Graft Dislocation Rate After Descemet Stripping Automated Endothelial Keratoplasty

Hood

Woodward

Bullard

et al. 2013

Cornea

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PURPOSE To determine the influence of pre-operative donor tissue characteristics on the graft dislocation rate after Descemet’s stripping automated endothelial keratoplasty (DSAEK). METHODS We retrospectively analyzed associations between donor tissue characteristics and graft dislocation rates for consecutive DSAEK surgeries performed in a four year period at a single institution. RESULTS From June 2007 to June 2011, 64 (18%) of 355 eyes underwent a procedure for graft dislocation. There were no differences in donor age, pre-operative endothelial graft thickness, pre-processing endothelial cell density, change in endothelial cell density after processing, time from death to tissue processing, or time from tissue processing to surgery between eyes that experienced dislocations and those that did not (P>.05 for each). The graft recipient’s corneal disease diagnosis, pre-operative corneal thickness, pre-operative visual acuity, glaucoma status, history of glaucoma surgery, and cataract surgery at the time of DSAEK were not associated with an increased rate of dislocation (P>.05 for each). Recipients who experienced graft dislocation were significantly older (73.6 vs. 70.2 years, P=.03) and more likely to undergo subsequent repeat transplantation (29.7% vs. 10.7%, P<.0001). CONCLUSIONS We found no correlation between any corneal donor tissue characteristic and graft dislocation after DSAEK. Graft dislocation was more common in older recipients. Patients with dislocation had a higher rate of subsequent transplantation.

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“…DSAEK shows the best outcomes when performed in phakic or pseudophakic eyes with diseased endothelium,[ 19 ] as surgery in aphakic, vitrectomized eyes, carries a high risk of lenticule detachment/dislocation, and primary graft failure because of inadequate air tamponade. [ 19 20 ] This explains the preference for PKP in aphakic eyes over DSAEK.…”

Section: Discussionmentioning

confidence: 99%

Changing pattern of utilization of human donor cornea in India

Gogia

Gupta

Agarwal

et al. 2015

Indian J Ophthalmol

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Purpose:To review the changing pattern of donor, corneal utilization in an eye bank at a Tertiary Care Center in Northern India by analyzing the trend in the years 2003, 2008, and 2011.Methods:A retrospective review of eye bank records for 3 years (2003, 2008, and 2011) was performed at the National Eye Bank. Details including a clinical grade of donor cornea, indication of corneal transplantation (therapeutic or optical), type of procedure (penetrating or lamellar keratoplasty [LK]), and clinical diagnosis of the graft recipients were recorded. Primary outcome measure was to observe any preference toward LK, judicious usage of donor corneal tissue, and impact of lamellar corneal transplant in the usage of donor corneas. Secondary outcomes included overall utilization rate and change in trend of indication for keratoplasty.Results:A total of 673, 745, and 864 corneas were retrieved in the years 2003, 2008, and 2011, respectively. The percentage of donor corneal utilization increased significantly over time with the rate being 65.08%, 70.06%, and 68.29%, respectively, in the years 2003, 2008, and 2011 (P = 0.014); however, this change was reflected only in the usage of nonoptical grade corneas and not for the optical grade corneas. There was an overall increase in lamellar corneal procedures for any clinical grade of cornea (P = 0.0019); number of Descemet's stripping automated endothelial keratoplasty (DSAEK) procedures increased significantly (P < 0.001), particularly for pseudophakic corneal edema (PCE) (P = 0.0085) and failed graft (P = 0.002). Significant increase in the utilization of nonoptical grade corneas was observed over the years (P = 0.005), though the utilization did not increase significantly for optical purposes viz., LK (P = 0.08).Conclusions:Utilization rate of donor corneas increased over the years, primarily due to increase in usage of nonoptical grade corneas for therapeutic purposes. There was a procedural shift toward DSAEK for PCE and failed graft. However, an increase in usage of nonoptical grade corneas for LK, a single donor corneal tissue for two recipients, and retrieval or utilization of optical grade cornea was not observed.

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Management and Outcomes of Descemet Stripping Automated Endothelial Keratoplasty With Intraocular Lens Exchange, Aphakia, and Anterior Chamber Intraocular Lens

Abstract: In comparison with uncomplicated DSAEK cases, higher graft and IOL dislocations were observed in cases involving IOL exchanges, ACIOLs, or aphakia.

Cited by 31 publications

References 29 publications

Posterior iris-claw aphakic intraocular lens implantation and Descemet membrane endothelial keratoplasty

Posterior iris-claw aphakic intraocular lens implantation and Descemet membrane endothelial keratoplasty

Influence of Preoperative Donor Tissue Characteristics on Graft Dislocation Rate After Descemet Stripping Automated Endothelial Keratoplasty

Changing pattern of utilization of human donor cornea in India

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