Abstract
Purpose: To report a novel Y-suture transfixation technique to improve success rate of high-risk Descemets stripping automated endothelial keratoplasties (DSAEK). Design: Retrospective non-comparative case series. Participants: Twenty five high-risk patients undergoing DSAEK at one tertiary care institution. Methods: A retrospective evaluation of consecutively enrolled high-risk DSAEK cases performed by three surgeons at one institution during a 3-year period (2007-2010). Main outcome measures were graft adherence and suture-related complications. Results: Highrisk factors were defined as followed: prior incisional glaucoma surgery (58%), presence of vitreous in the anterior chamber (15%), anterior chamber intraocular lens (8%), graft dislocation (8%), previous DSAEK (8%), and iris trauma/aphakia (3%). Twenty-five high-risk patients underwent DSAEK with Y-suture transfixation. Postoperative follow-up ranged from 3 to 27 months. One patient had dislocation due to hypotony from prior trabeculectomy (4%), requiring repeat DSAEK. Neither primary graft failure nor suture-related complication was observed. Conclusion: The Y-suture transfixation technique is associated with improved success rate of high-risk DSAEK transplant.
Highlights
Endothelial keratoplasty (EK) has become the preferred surgical remedy for corneal endothelial diseases
The success of EK, Descemet stripping with automated endothelial keratoplasty (DSAEK), is largely due to its remarkably expeditious visual rehabilitation and favorable complication rates compared to penetrating keratoplasty (PKP) [2]-[6]
[7] Derived from posterior lamellar keratoplasty pioneered by Melles [8] [9] and later modified by Terry [3] [10] and others, DSAEK has revolutionized the treatment of corneal endothelial disease
Summary
Endothelial keratoplasty (EK) has become the preferred surgical remedy for corneal endothelial diseases. The Eye Bank Association of America reported that numbers of corneal tissue provided for EK procedures increased by 1287% from 1429 in 2005 to 18,375 in 2008 [1]. The success of EK, Descemet stripping with automated endothelial keratoplasty (DSAEK), is largely due to its remarkably expeditious visual rehabilitation and favorable complication rates compared to penetrating keratoplasty (PKP) [2]-[6]. Among the repertoire of EK procedures, DSAEK emerges as the procedure of choice for the corneal surgeons. [7] Derived from posterior lamellar keratoplasty pioneered by Melles [8] [9] and later modified by Terry [3] [10] and others, DSAEK has revolutionized the treatment of corneal endothelial disease.
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