Transcript Descemet Stripping Automated Endothelial Keratoplasty in

Etiological and decision making factors
for repeat DSAEK or PK in cases of
failed Descemet stripping automated
endothelial keratoplasty
First and Presenting author: Jeewan S. Titiyal
Co-authors: Manpreet Kaur, Tarun Arora, Rajesh Sinha
Affiliation: RP Centre. AIIMS, New Delhi, India
No author has any financial interests
Purpose
To evaluate the causes for failure of Descemet Stripping
Automated Endothelial Keratoplasty (DSAEK) and study
factors for deciding on the type of repeat keratoplasty
(PK/DSAEK)
Methodology
• Type of study: Retrospective case series
•
All cases of DSAEK performed between May 2012
to April 2014 at RPC, AIIMS (95 eyes)
Parameters evaluated
• Demographic profile
• Primary Indication for DSAEK surgery
• Postoperative course, and
• Secondary interventions
Outcome measures (at final visit)
• Best-corrected distance visual acuity (BCDVA)
• Intraocular pressure
• Graft clarity and
• Central corneal thickness
Results
• Mean (±SD) duration of follow up: 12.3 (±2.1) months
• Mean (±SD) preoperative central corneal thickness:
680 (±32.7) microns
• Of the total 95 DSAEK cases performed, 78 (82.1%) were
successful at the final follow up
• However, 17 (17.9 %) grafts had failed at final follow up
Results (contd.)
•
Primary etiology of cases with graft failure (17):
o Pseudophakic bullous keratopathy (5)
o Herpetic endothelitis (2)
o Iridocorneal endothelial syndrome (1)
o CHED (2)
o Secondary scleral fixated IOL with endothelial
decompensation (3) and
o Peripheral anterior synechiae with secondary glaucoma (4)
Results (contd.)
Of the 17 eyes with graft failure,
 9 underwent repeat DSAEK including all cases with
primary graft failure.
 8 underwent full thickness penetrating keratoplasty
Factors for repeat
penetrating keratoplasty
• Increased Central corneal thickness
• Peripheral anterior synechiae
• Secondary glaucoma
Results (contd.)
• Eight cases that underwent full thickness penetrating
keratoplasty included:
o Previous DSAEK with eccentric graft (2/4)
o Previous SFIOL surgery (3/3)
o CHED (1/2), ICE (1/1) and
o Herpetic endothelitis (1/2)
Conclusion
• Primary graft failure was the leading cause of failure for
DSAEK in our series
• Diseases associated with peripheral anterior synechiae,
post-operative increased inflammations were associated
with higher rate of DSAEK failure
Conclusion (contd.)
• All cases with primary graft failure could undergo
successful repeat DSAEK surgery
• All cases with previously operated SFIOL, ICE, and half of
cases with Herpetic endothelitis, CHED and Eccentric
graft required a penetrating keratoplasty after failed
DSAEK procedure