Visual outcomes and graft survival in eyes with different indication for Descemet's stripping endothelial keratoplasty

Session Details

Session Title: Cornea Surgical I

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 08:43

Venue: Boulevard B

First Author: : N.Fernandez Meijide ARGENTINA

Co Author(s): :    J. Bekerman              

Abstract Details

Purpose:

To evaluate graft survival and visual outcomes in patients who underwent Descemet's stripping endothelial keratoplasty (DSEK) for Fuchs dystrophy (FD), pseudophakic bullous keratopathy (PBK), anterior chamber intraocular lens bullous keratopathy (ACIOLBK) , failed penetrating keratoplasty (fPK) and failed DSEK (fDSEK)

Setting:

Cornea Service. Department of Ophthalmology, Italian Hospital in Buenos Aires, Argentina.

Methods:

Visual outcomes of the first 71 consecutive cases of DSEK performed by a single surgeon between January 2010 and June 2013 were analyzed retrospectively. Donor corneal- scleral rims were dissected with a microkeratome and were cut with a trephine. The graft was inserted using Busin funnel glide (Moria, Anthony, France).

Results:

Mean patient age at surgery was 74.34 +/- 8.86 years. 31 eyes (43,66%) were treated for PBK, 24 (33,80%) for FD, 9 (12,68%) for fPK, 4 (5,63%) for ACIOLBK, 2 (3,28%) for fDSEK and 1 (1,41%) for fPK and DSEK . 28 eyes (39,43%) had glaucoma, 15 eyes (23,81,90%) had maculopathy and 17 eyes (26,15%) had history of complicated cataract surgery. Mean follow up was 8.07 +/- 7.85 months. Postoperative best corrected visual acuity (BCVA) was 20/63 +/-20/80 for all cases, 20/40 +/- 20/63 for PBK, 20/63 +/- 20/80 for FD, 20/125 +/- 20/160 for fPK, 20/50 +/-20/125 for ACIOLBK, 20/100 +/-20/100 for fDSEK and 20/100 for fDSEK and PK. BCVA was 20/40 +/- 20/80 in eyes without comorbidities and 20/80 +/- 20/80 in eyes with comorbidities. Mean endothelial cell density preoperatively and posoperatively was 2649.19 +/- 246.36 and 1512.42 +/- 484.38 cells/mm2 respectively. Mean central corneal thickness postoperatively was 677.47 +/-115.03 microns and mean central thickness of the endothelial graft was 170.46 +/-54.38. fPK group had less mean endothelial cell density (1136 +/- 688 cells/mm2) and thicker mean central corneal and endothelial graft thickness (786.42+/-198.96 microns and 245.2+/-107.02 respectively) than the other groups

Conclusions:

DSEK provides better visual outcomes in the cases with PBK or FD than cases with fPK or fDSEK. Nevertheless, comorbidities such as glaucoma, maculopathy and history of complicated cataract surgery limits the results of the intervention. Also, fPK had less endothelial cell density and thicker mean central corneal and endothelial graft thickness than other causes of indication of DSEK.

Financial Interest:

NONE