TM-DSEK in failed PK: advantages over PK in a case series

Session Details

Session Title: Cornea: Surgical I

Session Date/Time: Tuesday 08/09/2015 | 08:00-10:30

Paper Time: 09:42

Venue: Room 10

First Author: : R.Borbara UK

Co Author(s): :    A. Turnbull   S. Makuloluwe   P. Hossain   D. Anderson           

Abstract Details

Purpose:

To highlight less recognised advantages of performing Thin Manual Descemet Stripping Endothelial Keratoplasty (TM-DSEK) within a previous Penetrating Keratoplasty (PK).

Setting:

Ophthalmology Department, University Hospital Southampton, Southampton, UK and private practice Southampton, UK.

Methods:

A database search identified patients who underwent secondary TM-DSEK within a previously failed PK. Sample cases are presented to highlight where employment of this technique offered advantages over a repeat PK.

Results:

1)Graft-host junction infection developed post-operatively requiring anti-fungal treatment and steroid cessation. Resilience of the TM-DSEK lenticule to rejection and infection-spread allowed rapid recovery without graft compromise. 2)Predictability of spherocylindrical refractive change induced by TM-DSEK enabled early refractive optimisation using a toric piggyback intraocular lens. 3)Inferotemporal PK dehiscence occurred following blunt trauma. The larger diameter endothelial graft prevented complete dehiscence. Re-suturing was performed without lenticule damage, despite loss of both primary and piggyback IOL. 4)TM-DSEK reduced intra-operative risks compared with repeat PK in an extreme axial myope with glaucoma, and allowed more rapid visual recovery than would be predicted with PK.

Conclusions:

This small case series serves to illustrate how secondary DSEK within PK may confer advantages over repeat PK in terms of tectonic stability, resistance to infection, refractive stability and reduced intra-operative risk. Although larger studies are required to demonstrate statistical significance, secondary DSEK is not only a viable alternative to repeat PK, but may be considered preferable in certain clinical situations.

Financial Interest:

NONE