Outcomes of Resident-Performed Descemet's Stripping Automated Endothelial Keratoplasty

Abstract

Purpose This article aimed to evaluate outcomes of resident-performed Descemet's stripping automated endothelial keratoplasty (DSAEK). Methods This is a case series of patients who underwent DSAEK performed by PGY-4 ophthalmology residents at Lyndon B. Johnson Hospital from January 2013 to August 2016 staffed by a fellowship-trained cornea specialist. Patients with less than 1 month of follow-up were excluded. Demographics, baseline ocular characteristics, and intraoperative data were recorded. Vision and graft status were recorded at 1 week, 1 month, 3 months, and the last follow-up visits. Surgical failure was defined as graft detachment within 1 week of surgery and/or primary graft failure within 3 months of surgery. Results Eighteen eyes of 18 patients who followed up for 14.9 months (±12.9) were included. Mean age of patients was 60.9 years (±13.2). Indications for DSAEK included pseudophakic bullous keratopathy (10), Fuchs endothelial dystrophy (4), and other causes of endothelial dysfunction (4). Eleven (61%) eyes had prior ocular surgery, and 7 (39%) had prior glaucoma surgery. There were no postoperative graft detachments and two (11%) primary graft failures. There was one primary graft failure in a glaucoma patient. Of the 16 graft successes, logMAR visual acuity improved by 0.46 logMAR (±0.73) from baseline. Conclusion With appropriate staffing by an experienced cornea surgeon, DSAEK with residents as the primary surgeons is a safe and effective procedure with reasonably good outcomes.