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Descemet Stripping Endothelial Keratoplasty (DSAEK)
Following Penetrating Keratoplasty (PK)
Amit Patel, FRCOphthMassimo Busin, MD
Villa Serena Hospital, Forli’, ItalyFondazione Banca degli Occhi del Veneto, Venice, Italy
------------------------------------------------------------------------------------------------------------Financial Disclosure
Pfizer (UK) Ophthalmic Fellowship Award (AP)Travel reimbursements and royalties from Moria, Antony, France (MB)
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PURPOSE
• To Evaluate the Outcomes of DSAEK in Eyes With Post-Penetrating Keratoplasty (PK) Endothelial Decompensation.
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METHODS
• Prospective Study– January 2007 to June 2009
• Cause of Endothelial Failure
• UCVA, BCVA, ECC noted at 1, 3, 6, 12 and 24 months post-DSAEK
• Complications
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SURGICAL TECHNIQUE
• Descemetorhexis Within PK wound and Peripheral Iridotomy
• Graft Delivery with Busin Glide Through a 3.2mm Clear-Corneal Tunnel
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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
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RESULTS• 31 Cases Recruited• 29/31 Immunologic Graft
Failure• All DSAEK Grafts Larger
than Original PK(8.5-9.0 mm vs 7.5-8.0 mm)
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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
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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
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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)
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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