[Show abstract][Hide abstract] ABSTRACT: To describe a new surgical technique for deep stromal anterior lamellar keratoplasty.
In eye bank eyes and sighted human eyes, aqueous was exchanged by air, to visualise the posterior corneal surface--that is, the "air to endothelium" interface. Through a 5.0 mm scleral incision, a deep stromal pocket was created across the cornea, using the air to endothelium interface as a reference plane for dissection depth. The pocket was filled with viscoelastic, and an anterior corneal lamella was excised. A full thickness donor button was sutured into the recipient bed after stripping its Descemet's membrane.
In 25 consecutive human eye bank eyes, a 12% microperforation rate was found. Corneal dissection depth averaged 95.4% (SD 2.7%). Six patient eyes had uneventful surgeries; in a seventh eye, perforation of the lamellar bed occurred. All transplants cleared. Central pachymetry ranged from 0.62 to 0.73 mm.
With this technique a deep stromal anterior lamellar keratoplasty can be performed with the donor to recipient interface just anterior to the posterior corneal surface. The technique has the advantage that the dissection can be completed in the event of inadvertent microperforation, or that the procedure can be aborted to perform a planned penetrating keratoplasty.
British Journal of Ophthalmology 04/1999; 83(3):327-33. DOI:10.1136/bjo.83.3.327 · 2.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the outcome of Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with a retained anterior chamber intraocular lens (ACIOL).
A retrospective review of 11 patients with corneal decompensation and ACIOL who underwent DSAEK was performed. All patients except 1 had open-loop style ACIOLs, and in all cases, there was adequate anterior chamber depth. At the time of surgery, 6 patients had a temporary suture to secure their graft, 2 of which were retained from the insertion method, and the other 4 were placed additionally. Postoperatively, the rate of donor detachment, graft clarity, corneal pachymetry, and visual acuity were noted.
There was only 1 graft dislocation postoperatively, which was reattached successfully by air injection. There was 1 primary graft failure (without dislocation) among the 11 patients during the mean follow-up of 12 months (range: 6-25 months); at last follow-up, the visual acuity had improved in all the other 10 patients.
This series demonstrates that DSAEK can be performed successfully in patients with existing ACIOLs. These early outcomes suggest that DSAEK alone may be considered as an alternative to a lens exchange with DSAEK in patients with adequate anterior chamber depth.
[Show abstract][Hide abstract] ABSTRACT: To compile a survey of complications during and after Descemet's stripping with automated endothelial keratoplasty (DSAEK) in 118 eyes conducted by cornea subspecialists at a single academic center.
Retrospective case series.
One hundred eighteen eyes undergoing DSAEK in 99 patients.
Outcomes of DSAEK performed in 118 eyes by 10 surgeons were reviewed retrospectively. Sixty-four eyes had pseudophakic bullous keratopathy. Forty-one had Fuchs' endothelial dystrophy and cataract. Three had aphakic bullous keratopathy. In 10 eyes, previous DSAEK performed at the same institution failed. Complications of DSAEK were noted from the intraoperative and postoperative periods. Detached DSAEK grafts were repositioned, rebubbled, or both immediately after diagnosis of this complication.
Intraoperative and postoperative complications of DSAEK.
Graft detachment was the most common type of complication encountered. In 27 (23%) of 118 eyes, graft detachments were observed. Twenty-five eyes with detached grafts successfully were repositioned or rebubbled after surgery, or both. In 1 eye, a previously detached graft reattached spontaneously. In 1 aphakic eye, the graft detached into the vitreous cavity. In 17 eyes, successful reattachment of the cornea occurred (68%). Twenty-one of the 118 eyes were considered to have failed DSAEK, meaning that persistent edema was present after DSAEK. Seven (6%) demonstrated graft rejection. In 5 eyes (4%), retinal detachment (RD) developed. In 6 (5%), cystoid macular edema developed. In 1 aphakic patient, an air bubble could not be maintained during surgery, and sulfur hexafluoride was injected into the anterior chamber. In 1 eye (1%), epithelial ingrowth developed. One eye (1%) demonstrated blood in the graft interface. In 1 eye (1%), a limited intraoperative suprachoroidal hemorrhage occurred. Two eyes (2%) had pupillary block after surgery that resolved with removal of the air bubble.
Descemet's stripping with automated endothelial keratoplasty has become a popular and effective treatment for corneal endothelial dysfunction, but complications resulting from DSAEK do occur. Graft detachment is the most common complication, but postoperative repositioning or rebubbling, or both, allow for graft reattachment in most cases. Other complications found in this series were graft failure, graft rejection, cystoid macular edema, RD, suprachoroidal hemorrhage, and pupillary block. Retained Descemet's membrane and epithelial ingrowth, are potential causes of dislocation.
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