Abstract
BackgroundA major obstacle that academic institutions face is the steep learning curve for cornea fellows initially learning to perform Descemet Stripping Endothelial Keratoplasty (DSEK). The purpose of this study is to evaluate the outcomes of complex DSEK performed by cornea fellow supervised by an attending surgeon at an academic institution.MethodsPatients who underwent a complex DSEK procedure performed by a cornea fellow during the years 2009-2013 were included. All the surgeries were supervised by the same cornea attending. All patients had a minimum follow-up of 6 months. Charts were reviewed for demographic data, intraoperative and postoperative complications and clinical outcomes. Corneal graft survival was calculated using the Kaplan-Meier analysis.ResultsFifty-seven eyes of 55 patients (mean age 77.5 ± 8.5 years) were included in the study with a mean follow-up time of 16.4 ± 15.6 months. Previous graft failure, presence of a tube and history of trabeculectomy were the leading diagnoses to define the surgery as complex. No intraoperative complications occurred. In 21.1% of cases a corneal graft detachment was documented in the first postoperative day. Mean visual acuity improved from 1.06 LogMAR (20/230) preoperatively to 0.39 LogMAR (20/50, p < 0.001) by the sixth postoperative month and to 0.52 LogMAR (20/65, p < 0.001) at the last follow-up visit. Graft failure rate was 29.8%. Kaplan-Meier analysis found a 67.2% graft survival rate at 20 months.ConclusionsComplex DSEK can be performed successfully with an acceptable postoperative complication rate by cornea fellows during their training period when supervised by an experienced attending.
Highlights
A major obstacle that academic institutions face is the steep learning curve for cornea fellows initially learning to perform Descemet Stripping Endothelial Keratoplasty (DSEK)
Descemet Stripping Endothelial Keratoplasty (DSEK) has been adopted worldwide as an alternative to penetrating keratoplasty in corneal pathologies restricted to the endothelium such as Fuchs endothelial dystrophy and pseudophakic bullous keratopathy
DSEK has its limitations in complex cases such as in the presence of previous tube shunt procedures, trabeculectomies and previously failed DSEK or penetrating keratoplasty grafts [4,5,6,7,8]
Summary
A major obstacle that academic institutions face is the steep learning curve for cornea fellows initially learning to perform Descemet Stripping Endothelial Keratoplasty (DSEK). Descemet Stripping Endothelial Keratoplasty (DSEK) has been adopted worldwide as an alternative to penetrating keratoplasty in corneal pathologies restricted to the endothelium such as Fuchs endothelial dystrophy and pseudophakic bullous keratopathy. In these cases, DSEK has shown overall better results than penetrating keratoplasty [1] including a faster visual recovery, decreased astigmatic change, and reduced risk of suture related complications [2, 3]. In DSEK performed on patients with tube shunts, the tube needs to be revised to provide enough room for the donor graft in the anterior chamber and to prevent future trauma to the endothelium [4]. Patients with trabeculectomies and tube shunts usually have advanced optic nerve glaucomatous
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