Complications and management in Descemet's stripping endothelial keratoplasty: Analysis of consecutive 430 cases.
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Date
2014-02
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Abstract
Purpose: To analyze the complications and their managements in Descemet’s stripping endothelial
keratoplasty (DSEK) in consecutive 430 cases by single surgeon in a tertiary eye hospital. Materials and
Methods: 430 eyes of 366 patients with endothelial dysfunctions scheduled for DSEK, were analyzed
retrospectively. In all cases donor dissection was performed manually, and ‘Taco’ insertion and unfolding
technique was used. Intra-operative and postoperative complications with their managements and
outcomes were reviewed retrospectively. Periodic endothelial cell density was analyzed for each patient
till the last visit. Follow-up period was between 3 to 60 months (mean 18.7 months). Results: 13 (3.0%)
eyes had operative complications during donor dissection and 16 (3.7%) had during recipient procedure.
In 7 (1.6%) eyes, donor lenticule was replaced with a new one during the surgery. In early postoperative
period, 21 (4.9%) eyes had donor dislocation and 12 (2.8%) eyes had air-induced pupillary block; and they
were managed immediately. 2 cases had primary graft failure and in 1 case had postoperative bacterial
endophthalmitis requiring evisceration. In late postoperative period, 48 (11.3%) eyes had secondary glaucoma
and 14 (3.3%) eyes had late secondary graft failure. Endothelial rejection occurred in 5 (1.2%) cases. Mean
endothelial cell loss was 19.7% after 3 months and 54.2% after 5 years. Total graft failure in this series was
31 (7.2%) and in 17 cases re-DSEK was performed successfully. Conclusions: Both operative and
postoperative complications do occur in DSEK. Most of these complications can be managed by medical
or appropriate surgical means. Some of the complications can be avoided and reduced with experience.
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Descemet’s stripping endothelial keratoplasty, complications, donor dislocation, endothelial cell loss, graft failure, management
Citation
Basak Samar K, Basak Soham. Complications and management in Descemet's stripping endothelial keratoplasty: Analysis of consecutive 430 cases. Indian Journal of Ophthalmology. 2014 Feb ; 62 (2): 209-218.