Posters

Repeat keratoplasty for failed Descemet’s stripping automated endothelial keratoplasty: factors affecting decision-making

Poster Details

First Author: J.Titiyal INDIA

Co Author(s):    M. Kaur   M. Gagrani   F. Shaikh              

Abstract Details

Purpose:

To evaluate the clinical factors influencing decision making regarding repeat descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty (PKP) in cases of failed DSAEK

Setting:

Dr Rajendra Prasad Centre for Ophthalmic sciences, AIIMS, New Delhi, India

Methods:

Retrospective observational study of cases with failed DSAEK admitted to our centre for a repeat keratoplasty over five years (Jan. 2013- Dec. 2017) was undertaken. Cases with incomplete medical records were excluded. Perioperative details and type of repeat keratoplasty were recorded

Results:

A total of 94 eyes with failed DSAEK were evaluated. Repeat DSAEK was performed in 66% and PKP in 34% cases. Significantly increased odds for PKP were associated with stromal scarring (OR= 2.9), trainee surgeons (OR=4.05), intraoperative complications (OR= 4.58), SFIOL/ ACIOL in situ (OR=33.8), secondary glaucoma (OR=3.02), PAS (OR=8.6), preoperative corneal thickness (OR=1.01), time to primary surgery (OR-=1.03), post-DSAEK host thickness (OR=1.01) and time interval from graft failure to re-graft (OR=1.18). All eyes with CHED, bee-sting induced decompensation, Axenfeld Rieger syndrome and multiple failed grafts underwent PKP. All cases requiring surgery for glaucoma underwent PKP (p<0.001).

Conclusions:

Decision making for repeat keratoplasty after failed DSAEK is influenced not only by the ocular state at the time of re-graft, but by the entire preoperative, intraoperative and postoperative course of the primary surgery

Financial Disclosure:

None