Complicações em ceratoplastia endotelial com desnudamento da Descemet (DSEK)

Abstract

To describe the complication rate and type of intraoperative and postoperative complications of Descemet stripping endothelial keratoplasty (DSEK). Retrospective medical records review of patients who underwent DSEK between 2008 and 2010 at the Sorocaba Ophthalmological Hospital. The study was descriptive, using a quantitative approach. One hundred nineteen eyes of 118 patients were evaluated. According to the diagnoses, most patients were diagnosed with Fuchs' dystrophy (60 eyes, 50.4%), followed by patients with pseudophakic bullous keratopathy in 55 eyes (46.2%). The most common procedure performed was DSEK alone, performed in 65 eyes (54.6%), followed by the DSEK associated to phacoemulsification (PHACO-DSEK) in 47 eyes (39.5%) and DSEK associated to other surgeries (7 eyes, 5.9%). Eight patients were excluded from the study due to insufficient information in the surgical record. In relation to the intra-operative complications, isolated cases of pupillary block, irregular manual dissection of button, inverted implantation of the button, button-holing and posterior capsule rupture were noticed. Among the documented early postoperative complications, button detachment was observed in 21.5% of the DSEK alone group; 34.0% in PHACO-DSEK group and 57.1% when DSEK was held jointly with other surgical techniques. Regarding to late complications, interface haze was observed in 16.9%, 8.5% and 14.2%, and glaucoma was observed in 4.6%, 2.1% and 14.2% in DSEK, PHACO-DSEK and DSEK associated to other techniques, respectively. Post rejection graft failure was observed in 15.3% and 12.7% of the eyes after DSEK and. PHACO-DSEK, respectively. Endothelial corneal transplant accomplished in this sample showed a high rate of complications when compared to the conventional penetrating keratoplasty. The most frequent complications were related to detachment of the button and graft failure.