Use of a Novel Y- Suture Technique to Reduce Detachments in Descemet’s
Stripping Automated Endothelial Keratoplasty (DSAEK)
Habeeb Ahmad, MDMartin Heur, MD, PhD
Sam Yiu, MDJonathon Song, MDRonald Smith, MD
*The authors have no financial interest in the subject matter of this poster
DSAEK vs. Penetrating Keratoplasty:
Avoids open sky surgery Faster recovery time Less sutures: reduced astigmatism, smoother anterior surface, less suture related complications Improved tectonic stability Reduced graft failure from ocular surface Small refractive shift/Good visual outcomes
Introduction: Advantages of DSAEK
The Rise of DSAEK
2006- 6,027 tissues provided for Endothelial Keratoplasty(EK) procedures 134%2007- 14,159 tissues provided for Endothelial Keratoplasty procedures 30%2008- 18,375 tissues provided for Endothelial Keratoplasty procedures
2007- 85% of all transplants for endothelial disease were EK surgical procedures2008- Total transplants rose 5.7% (39,39141,652)
* Eye Bank Association of America Statistics Report 2008
DSAEK: Limitations in the Literature
Posterior Graft Dislocation (0-82%, average 14.5%) Endothelial Cell Loss (1 year Postoperatively: 24 - 61%) Primary Graft failure (0-29%) Pupillary Block/Steroid Induced Glaucoma (0-15%) Hyperopic Shift (0.7D - 1.5D, mean 1.1D)
*Lee et al. Descemet’s Stripping Endothelial Keratoplasty: Safety & Outcomes. Ophthalmology 2009;116:1818-1830
Purpose
To find a method to reduce/prevent lenticule detachments, particularly, in high risk patients including those with associated aphakia, glaucoma, blebs, tubes, iris abnormalities and vitreous in the AC.
Ideal method would be:1- Safe2- Repeatable3- Technically simple4- Carry low risk of infection5- Avoid gross manipulation of graft6- Achieve anatomic and visual success7- Reversible8- Inexpensive
Retrospective review:• 26 non-consecutive DSAEK procedures
using Y- suture technique• Timeframe: 2007- 2009• Performed by three surgeons at the
university hospital setting
Patient demographics: • 25 Patients: 12 Males, 13 Females• Ages: Range: 27 - 95 Mean Age: 69
Methods
Introduction to the Y-Suture Technique
3 Anchoring Sutures in Y Formation: Full thickness, Peripheral, Tangential, Used to tether small portion of lenticule Performed after placing air bubble Using 10.0 Nylon sutures Knots are not buried Removed after 1 week
Demographic Results
Reasons for Choosing Y-Suture DSAEK
15%
8%
8%
58%
8%
3%
Glaucoma (tubes, blebs)
Vitreous Involvement
ACIOL present
Previous Graft Dislocations
Previous DSAEK (withoutdislocations)
Iris Trauma/Aphakia
Color Slit Lamp Photo: 1 week after Y-Suture DSAEK
Results: Y-Suture DSAEK in High Risk Patients
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Fully Attached Grafts
Dislocated Grafts
Primary Graft Failure
Graft Rejection
Suture RelatedComplications
97%
0% 0%0%3%
Anterior Segment OCT of the onlydislocation in the study group. Dislocation was a result of a severe hypotony with bleb leak
Sutured graft with interface fluid Two months later: fully dislocated graft
Repeat DSAEK after revision of bleb Graft remains well adhered months later
Suture
1 2
43
DSAEK surgery when successful, results in excellent visual outcomes
In high risk patients (glaucoma, previous dislocations, iris abnormalities, vitreous in AC), graft detachment can be significantly higher than typical patients limiting both surgical and visual success
Use of the Y suture technique during DSAEK is an effective, safe, reproducible and inexpensive mean to reduce detachments in these high risk patients
Conclusions
