Pre-Descemet's endothelial keratoplasty (PDEK): our journey to date

Session Details

Session Title: Cornea Surgical I

Session Date/Time: Monday 12/09/2016 | 08:00-10:30

Paper Time: 09:20

Venue: Hall C1

First Author: : L.Daniel Ponniah INDIA

Co Author(s): :    A. Agarwal                    

Abstract Details

Purpose:

To evaluate the clinical outcomes of Pre Descemets Endothelial Keratoplasty (PDEK) in varied endothelial dysfunctions and to compare with conventional procedures of Penetrating Keratoplasty (PK) , Descemets Membrane Endothelial Keratoplasty (DMEK) and Descemets Stripping Endothelial Keratoplasty (DSEK) in our practice.

Setting:

Prospective observational case series of clinical outcomes of PDEK and Quality of life (QOL) evaluation over the period of last two years done at Dr.Agarwal's Eye Hospital Tirunelveli ,South India. Authors have no financial interests.

Methods:

IRB approval, Informed surgical consent obtained. Cases of varied endothelial dysfunctions namely Fuchs dystrophy, bullous keratopathies,failed corneal grafts,ICE and Pseudoexfoliation syndromes,Post hydrops corneas and post trabeculectomy glaucoma with endothelial dysfuctions were enrolled.{n=48} Surgical technique-With endothelial side up and 26gauge needle attached to 5ml airfilled syringe,pneumatic dissection of PreDescemets layer with a single bubble created,stained with Tryphan blue.A 7.5- 8mm donor tissue (PDEK graft) excised and implanted through medicel (MIL) injector, after conventional Descemets stripping of recipient cornea.Graft is unrolled,attached to the recipient cornea with air injection and endo illuminator assistance.

Results:

48 subjects enrolled.Mean followup was 90+/-15 days. 39 subjects(81.25%) achieved postoperative vision 20/60 or better. PDEK graft is possible in donor of any age against over 40 years with DMEK. PDEK mean surgical time was 43 minutes, significantly lower than DMEK(>90minutes). Endothelial preservation with PDEK(pneumatic dissection) was better than DMEK(manual dissection). Corneal thickness of PDEK was closer to normal and DMEK against DSEK. Quality of Life in PDEK, a day care procedure had better pain and recovery scores than PK( 7-10 days in PDEK vs 6-12 months in PK). No suture emergent adverse events with PDEK.

Conclusions:

Pneumatic dissection of PDEK graft was technically easier, better in endothelial preservation and could be done in donors of any age when compared to manual dissection of DMEK. Corneal thickness was closer to normal with PDEK than DSEK. QOL assessment with PDEK was definitely better than PK in terms of pain, recovery,quality of vision and negligible suture related adverse events. PDEK is our preferred endothelial keratoplasty of choice and endoilluminator is an essential part of our procedures.

Financial Disclosure:

NONE