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Descemet"s stripping automated endothelial keratoplasty in eyes with anterior synechiae

Session Details

Session Title: Cornea surgical I

Session Date/Time: Tuesday 08/10/2013 | 08:00-10:30

Paper Time: 08:36

Venue: Forum (Ground Floor)

First Author: : C.Russo ITALY

Co Author(s): :    L. Mattioli   P. Santorum   B. Filipovic Ricci   M. Busin     

Abstract Details

Purpose:

To evaluate the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) performed in eyes with endothelial decompensation and anterior synechiae.

Setting:

Prospective study. All procedures were performed by the same surgeon (M.B.). Eye Department of private hospital "Villa Igea" in Forli, Italy.

Methods:

Fourteen eyes with endothelial decompensation and anterior synechiae underwent combined DSAEK (conventional DSAEK n=8 , Ultrathin DSAEK with double microkeratome pass n=6) and synecholysis. In each case a standardized procedure was performed including: a. Descemet stripping under air; b. Synechiolysis under air or continuous irrigation from an anterior chamber maintainer placed at the 12 o’clock position; c. Microkeratome assisted preparation of a DSAEK graft then punched to 8.25 to 8.75 mm in diameter; d. Graft delivery by means of Busin glide through a 3.2 mm clear-cornea nasal tunnel, 1.0 mm in length; e. Air-tight suturing of all incisions. Best spectacle-corrected visual acuity (BSCVA), manifest refraction, anterior segment OCT and endothelial cell density were assessed preoperatively, as well as 3,6,12, 24, and 36 months after surgery.

Results:

All grafts were clear within one week after surgery. With an average follow-up of 12 months (range 1- 36 months) BSCVA was ?20/40 in 6 eyes(42.8%) and ? 20/60 in 11 eyes (78.5%); endothelial cell loss averaged 37.9%. No postoperative graft detachment occurred. Six eyes with pre-existing glaucoma (trabeculectomy n=3 and medically controlled n=3) didn’t require further intervention after DSAEK surgery. Synechiae recurred to a variable extent in 8 of 14 eyes. Late onset graft failure was seen in one case 3 years postoperatively.

Conclusions:

Corneal transparency and good visual acuity can be obtained and maintained after DSAEK performed in eyes with anterior synechiae. Although recurrence is possible, the presence of anterior synechiae does not seem to increase the risk of immunologic rejection.

Financial Interest:

... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented