Descemet Stripping Endothelial Keratoplasty Research Articles

A Detailed Analysis of Individuals Having Graft Failure After Corneal Transplantation

ABSTRACT Purpose To describe demographic and clinical characteristics of patients with graft failure after keratoplasty, determine the cause of graft failure and outcomes. Methods The charts of patients between 2008–2013 in the Cornea Service at Wills Eye Hospital with a history of a corneal transplant before the end of 2012 were retrospectively reviewed. Included were patients who had graft failure after corneal transplantation and had at least one year of follow-up after transplantation. Penetrating keratoplasty (PK) and Descemet’s stripping endothelial keratoplasty (DSEK) patients were analyzed separately. Results A total of 186 eyes of 170 patients with graft failure after a PK (156) or DSEK (30) procedures were identified. The baseline characteristics included 100 female and 70 male patients with an age between 0 and 90 years (median 63 years). At the time of surgery, 38% had three or more systemic diseases and 68% were using three or more systemic medicines. Mean follow up time for PK was nearly four times of DSEK. Only 2 DSEK eyes (7%) underwent a 3rd DSEK graft, while 47 (30%) PK eyes underwent a 3rd PK and 15 (10%) PK eyes underwent more than three PK procedures. Conclusions Most DSEK failures occurred in 1st year, while graft failure in PKs is scattered over years. Failure in DSEK is mostly due to graft or surgical risk factors but in PK mostly due to factors in the host. DSEK does not appear to be as affected by the patients’ demographic and clinical characteristics as much as PK.

Descemet Stripping Endothelial Keratoplasty in Patients With a Custom Foldable Silicone Artificial Iris: Safety and Efficacy Outcomes.

To assess outcomes of Descemet stripping endothelial keratoplasty (DSEK) in eyes with custom artificial iris (CAI) implantation. This is a retrospective, interventional, consecutive, surgical case series of patients who underwent DSEK after CAI implantation between 2010 and 2021 at 2 referral centers. Primary safety measures were loss of corrected distance visual acuity (CDVA), increase in intraocular pressure (IOP), development or progression of glaucoma, and intraoperative and postoperative complications. Efficacy measures were graft survival at year 1 and improvement in cosmesis at postoperative month 3. In general, measures were compared between baseline and postoperative year 1 while any complication was reported for the full follow-up period. Thirty-nine eyes of 39 patients were identified. 64.1% of eyes had acquired aniridia from trauma. The mean follow-up interval was 27.7 months (range 12.2-117.4). Median CDVA improved from logMAR 1.0 to 0.7 at year 1 (P = 0.0047). At the final follow-up, permanent loss of CDVA occurred in 25.6% of eyes, of which 90% was due to glaucoma. The most common postoperative complication was IOP elevation (66.7% of eyes). Graft survival at postoperative year 1 was 82.0% (95% confidence interval, 66.3-91.4). Secondary graft failure occurred in 28.2% of eyes at a mean duration of 39.7 months (SD 27.9 months) after DSEK. Cosmesis improved among 87.2% of eyes at postoperative month 3. DSEK is an effective procedure for addressing corneal edema in eyes with a CAI, but a majority develop elevated IOP and graft survival is shorter than in eyes without a CAI.

Outcome of Descemet membrane detachment repair using air descemetopexy and Descemet membrane suturing after cataract surgery

Outcome of Descemet membrane detachment repair using air descemetopexy and Descemet membrane suturing after cataract surgery

An Investigation of Keratoplasty Procedures and Their Outcomes in Iraq

Introduction: The treatment of corneal disorders involves the use of various forms of keratoplasty. The objective of this study was to provide a detailed description of the various types of keratoplasty procedures performed in Iraq, as well as their corresponding outcomes.
 Methods: An observational study was conducted at Al-Zahraa Teaching Hospital to document cases of keratoplasty. The collected data included age, gender, types of keratoplasty, indications, previous surgical or medical history, and postoperative outcomes. The types of keratoplasty included penetrating keratoplasty (PKP), deep anterior lamellar keratoplasty (DALK), and Descemet's stripping endothelial keratoplasty (DSEK). Additionally, we performed cataract surgery and intraocular lens (IOL) insertion for those with cataracts, using either IOLs with scleral fixation or IOLs with iris fixation. We complete the task on the first day following the purchase order, then the first week, the first month, and every six months thereafter. Prior to surgery, patients with corneal vascularization had laser photocoagulation of the blood vessels in the cornea.
 Results: Ages range from 4 to 90. People over 40 (60.8%) were the most common age group. The female prevalence was 52.9%. Right-eye illness was diagnosed 51.6% of the time. 60% of patients underwent PKP. 26.8% had DALK, 12.4% had DSEK. Post keratoplasty, the statistically-significant improvement-ratio was 68.5% as eyes best corrected visual acuity (BCVA) improvement, while 12.2% of eyes showed a decline in BCVA and 19.3% discharged with no changes in BCVA. Postoperatively, BCVA was significantly lower in cases with a duration below 1 year (1.5), and better among the duration > 3 years (0.5). The greatest improvements were seen in cases with infective keratitis (-0.7), corneal dystrophies (-0.6), and advanced keratoconus (-0.7) whereas the lowest rates were documented in cases with a graft rejection (-0.3), and bullous keratopathy (-0.3)
 Conclusion: Keratoplasty is associated with a substantial enhancement of visual acuity in the younger population. Infective keratitis, keratoconus, and corneal dystrophy produce the most optimal and superior results. The PKP method is the most frequently performed.

Descemet Stripping endothelial keratoplasty donor graft dissection following bowman-stromal Inlay preparation

This article outlines the dissection of donor grafts in descemet’s stripping endothelial keratoplasty (DSEK) after Bowman–Stromal inlay (BSI) tissue preparation. Following the femtosecond (FS) laser-assisted BSI for stromal augmentation in keratoconus, the donor cornea is transitioned to an artificial anterior chamber. The dissection of the DSEK graft is meticulously performed using blunt dissectors, considering the varying tissue thickness (thinner at the center and gradually thickening toward the periphery). This approach was successfully employed in three corneal donor tissues, facilitating six surgeries—three BSI and three DSEK. The intraoperative and postoperative courses were uneventful. This technique demonstrates the feasibility of utilizing a single donor tissue for both stromal augmentation and posterior lamellar keratoplasty (DSEK). Notably, the endothelial integrity of the donor tissue appears to remain unaltered following FS laser and subsequent manipulation by blunt dissectors. This holds promise in optimizing the utility of donor corneas for multiple therapeutic interventions.

Chinese expert consensus on corneal endothelial transplantation (2024)

Endothelial keratoplasty (EK) is an effective therapy for corneal endothelial diseases and mainly includes Descemet stripping endothelial keratoplasty and Descemet membrane endothelial keratoplasty. Compared with penetrating keratoplasty, EK has better vision rehabilitation and a lower rate of allograft rejection after surgery. However, EK poses a series of technical challenges, and varied complications may occur intraoperatively and postoperatively. A successful EK surgery depends on the standardized technical manipulations and the management of surgical complications. In order to standardize the surgical procedure of EK in China, the Cornea Group of Ophthalmology Branch of Chinese Medical Association has made a comprehensive discussion about indications of surgery, preoperative evaluation, surgical manipulations, and the management of complications based on the literature available thus far and clinical practice in China, and eventually established this consensus, which may guide corneal surgeons in performing the EK surgery.

Comparison of 20% SF6 and 6% C3F8 Gas for Anterior Chamber Tamponade in Endothelial Keratoplasty.

The aim of this study was to compare the rates of rebubbling after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty (DSEK) between patients who had anterior chamber (AC) graft tamponade with 20% sulfur hexafluoride gas (SF6) and 6% perfluoropropane gas (C3F8). The charts of 431 patients undergoing EK from June 8, 2010, to April 16, 2023, were reviewed. Patients undergoing EK alone as well as combined procedures with cataract extraction and intraocular lens implantation were included. Eyes with tube shunts, anterior chamber intraocular lenses, and large peripheral iridotomy with posterior loss of bubble, and patients undergoing cyclophotocoagulation or synechialysis were excluded. All rebubble procedures were performed within 1 month after initial surgery. A total of 346 eyes using SF6 and 167 eyes using C3F8 were analyzed. Overall, 46 eyes (9%) required rebubbling; 33 eyes (10%) in the SF6 group and 13 eyes (8%) in the C3F8 group. For those patients undergoing DMEK, the odds of requiring rebubbling in the C3F8 group were about 22% lower than that of patients in the SF6 group (operating room [OR]: 0.782; P < 0.001). For patients undergoing DSEK, however, the gas type did not significantly affect rebubbling rates (P = 0.99). For DMEK, utilization of 6% C3F8 as an AC tamponade was associated with a significantly lower odds of graft rebubbling compared with 20% SF6. Gas type did not result in a significant difference for DSEK. Utilization of 6% C3F8 for graft tamponade could be considered to reduce graft detachment rates in DMEK.

Modern techniques and features of selective keratoplasty

Selective keratoplasty involves replacing the affected layers of the cornea with similar donor tissue. In case of pathological changes in the middle and posterior stroma, deep anterior lamellar keratoplasty (DALK) is performed. Chronic corneal edema caused by endothelial dysfunction is an indication for endothelial keratoplasty - Descemet membrane endothelial keratoplasty (DMEK) or Descemet Stripping Endothelial Keratoplasty (DSAEK). Compared to penetrating keratoplasty (PK), these operations are characterized by a low risk of damage to intraocular structures and a relatively short rehabilitation period. Complications of selective keratoplasty include the formation of a false chamber between the lamellar graft and the recipient's cornea, ocular hypertension during anterior chamber air tamponade. Persistent epithelial defect can be a sign of primary graft failure in DALK, DSAEK and DMEK. Selective keratoplasty is characterized by a lower incidence of immune rejection than PK. In some cases, DALK can be complicated by corneal changes related to suture fixation of the graft. Long-term postoperative use of topical glucocorticoids can cause ocular hypertension and cataracts.

Descemet Endothelial Thickness Comparison Trial 1 (DETECT 1): outcome masked, placebo-controlled trial comparing two types of corneal transplant surgeries and effect of rho kinase inhibitors on endothelial cell loss protocol

BackgroundIt remains uncertain which endothelial keratoplasty (EK) technique yields the best outcomes while maintaining safety, particularly in eyes with coexisting ocular conditions. Moreover, the impact of endothelial cell loss (ECL)...

Trends in keratoplasty from central and northern India. Part II: Types of keratoplasty.

To report the types of keratoplasty and analyze trends over a period of two decades in central and northern India. This was a retrospective review of eye bank registries of six tertiary eye care centers located in central and north India from 2005 to 2021. The indications and various keratoplasty procedures were compared between 2005-2012 and 2013-2021 to analyze the trend. A total of 13,223 corneal grafts were performed, of which therapeutic penetrating keratoplasty (TPK) (5719, 43.3%) was the most common procedure, followed by optical penetrating keratoplasty (OPK) (5528, 41.8%), Descemet stripping endothelial keratoplasty (DSEK) (1279, 9.7%), deep anterior lamellar keratoplasty (DALK) (376, 2.8%), Descemet membrane endothelial keratoplasty (DMEK) (215, 1.6%), patch grafts (75, 0.6%), and keratoprostheses (31, 0.2%). Overall, OPK procedures decreased (-14.1%, P < 0.001), but TPK (+3.1%, P < 0.019), DSEK (+7.1%, P < 0.001), and DMEK (+1.9%, P < 0.001) procedures increased. Although there was an increasing trend in the use of DALK (+0.8%, P < 0.083) and keratoprostheses (+0.3%, P = 0.074) procedures, the trends were not statistically significant. In keeping with worldwide trends, an increasing trend in lamellar keratoplasties was observed in central and northern India during the past decade. The trend was significant for DSEK. However, as corneal ulcers and scars were the major indications for keratoplasty, TPK and OPK remained the most common procedures.

Descemet Membrane Endothelial Keratoplasty: 10-Year Cell Loss and Failure Rate Compared With Descemet Stripping Endothelial Keratoplasty and Penetrating Keratoplasty.

The aim of this study was to assess long-term endothelial cell loss (ECL) and graft failure with Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty (DSEK) versus penetrating keratoplasty (PK) performed for the same indications (primarily Fuchs dystrophy and pseudophakic corneal edema) in the Cornea Donor Study. This retrospective study included consecutive primary DMEK (529 recipients, 739 eyes) and DSEK cases (585 recipients, 748 eyes) with 1 or more endothelial cell density (ECD) measurements at 6 months to 16 years. Main outcomes were ECD, longitudinal ECL, and graft failure. Between 6 months and 8 years the ECD declined linearly by approximately 118 cells/mm2/yr after DMEK and 112 cells/mm2/yr after DSEK. Beyond 8 years postoperatively the rate of decline slowed substantially. Selective dropout from graft failure did not significantly affect the ECD trend. At 10 years, median ECL (interquartile range) was 63% (45, 73) with DMEK, 68% (48, 78) with DSEK, and 76% (70, 82) with PK (P = 0.01 DMEK vs. DSEK, P <0.001 DMEK vs. PK, and P < 0.001 DSEK vs. PK). The proportion of surviving grafts with 10-year ECD <500 cells/mm2 was 1.4% with DMEK, 7.3% with DSEK, and 23.9% with PK. The cumulative risk of graft failure between 6 months and 10 years was 5% with DMEK, 11% with DSEK, and 19% with PK (P < 0.001). Compared with PK and DSEK, DMEK had significantly lower ECL and significantly lower risk of secondary graft failure through 10 years.

Successful YAG Laser Treatment for Epithelial Ingrowth in Descemet Stripping Endothelial Keratoplasty Interface

Purpose: To present a case of epithelial ingrowth in the graft–host interface after Descemet stripping endothelial keratoplasty (DSEK) surgery that was successfully treated with an Nd:YAG Laser. Methods: A 79-year-old Caucasian female underwent a repeat DSEK 9 months after a prior DSEK graft rejection and subsequent failure. At her regularly scheduled 1-month follow-up visit, an asymptomatic dense white interface opacity was observed within the stromal interface, with an appearance consistent with epithelial ingrowth. The depth and location was confirmed by anterior segment optical coherence tomography. After initial observation, the opacity was noted to be growing over 2 months. The epithelial ingrowth cells were then treated with an Nd:YAG Laser. Results: The patient remained stable 12 months post laser treatment with no recurrence of epithelial ingrowth. Focal stromal pits were noted at the site of Nd:YAG Laser treatment within the DSEK graft stromal interface, but were not visually significant. Conclusions: Nd:YAG laser treatment is a safe and effective way to treat early-stage epithelial ingrowth in the interface after DSEK surgery.

Early Outcomes of an Artificial Endothelial Replacement Membrane Implantation After Failed Repeat Endothelial Keratoplasty.

The purpose of this study was to report the outcomes of a novel artificial endothelial replacement membrane implant for treating corneal edema after failed repeat endothelial keratoplasty (EK). This was a retrospective interventional case series. Patients with chronic corneal edema underwent removal of the EK graft and implantation of an artificial endothelial replacement membrane (EndoArt, EyeYon Medical, Israel) several months after 2 or more Descemet stripping endothelial keratoplasty procedures. The implant was secured to the posterior corneal surface using an air-gas bubble. Outcome measures included corrected distance visual acuity (logMAR), central corneal thickness, device-related complications, and ocular discomfort. Five eyes of 5 patients underwent EndoArt implantation. Six months after surgery, the synthetic endothelial replacement membrane was well-centered and adherent to the posterior corneal surface, with improvement in central corneal transparency in all patients. Corrected distance visual acuity increased from mean 1.26 ± 0.25 (logMAR) preoperatively to 0.74 ± 0.44 (logMAR) postoperatively (P = 0.06). Central corneal thickness significantly decreased from a mean of 805 ± 135 μm (excluding the EK graft) preoperatively to 588 ± 60 μm (excluding the EndoArt) postoperatively (P = 0.015). No severe device-related complications developed after surgery, although most patients required more than 1 air-gas bubble injection to achieve complete implant adhesion. All patients experienced preoperative reduction in subjective ocular pain. Synthetic endothelial replacement membrane implantation improves central corneal transparency and visual acuity in patients with failed EK and guarded prognosis for repeat keratoplasty. No significant implant-related adverse events occurred after surgery.

Scheimpflug Corneal Tomography Anterior Chamber Depth in Descemet Stripping Endothelial Keratoplasty Recipients.

Our study investigates whether preoperative anterior chamber depth (ACD) measured by Scheimpflug tomography could serve as a potential predictor of graft failure in eyes undergoing Descemet stripping endothelial keratoplasty (DSEK). A retrospective review was conducted on patients who underwent primary or repeat DSEK between January 2020 and August 2021 at Bascom Palmer Eye Institute. Charts from 378 primary and 192 repeat DSEK patients were reviewed and ultimately 47 primary and 21 repeat DSEK patients met criteria for inclusion. Data collection included demographics, preoperative ACD, best-corrected visual acuity, and length of follow-up. Demographics were similar between groups, and there was no significant difference in the average best-corrected visual acuity between the single and repeat DSEK groups preoperatively. Baseline preoperative ACD was greatest in the single DSEK group (3.51 ± 0.90 mm) when compared to baseline preoperative ACD in the repeat DSEK group (3.01 ± 0.67 mm, P = 0.003). The preoperative mean ACD was smallest in the repeat DSEK group before the second DSEK (2.94 ± 0.48 mm, P = 0.001). Preoperative baseline ACD was the only variable to affect graft survival time significantly (P = 0.012). The incidence of glaucoma diagnosis was similar in both groups (42.5% vs. 42.8%, P = 0.471). The diagnosis of glaucoma and presence of incisional glaucoma surgery did not affect the graft survival time (P = 0.129, P = 0.559) or need for repeat DSEK. Smaller baseline preoperative Scheimpflug ACD measurement may be a possible predictor of the need for repeat DSEK. Our study found that Scheimpflug ACD decreases with subsequent DSEK failure.

A Comprehensive Investigation Into the Outcomes of Descemet's Stripping Endothelial Keratoplasty (DSEK) as a Treatment for Corneal Endothelial Disorders.

Descemet's stripping endothelial keratoplasty (DSEK) has emerged as the preferred method for posterior lamellar keratoplasty, as it enables the replacement of the compromised host endothelium with a viable donor lamella. The objective of this study was to assess the impact of DSEK on surgical outcomes and visual acuity. The research was carried out from November 2019 to October 2021, encompassing a sample of 18 patients (18 eyes) who satisfied the inclusion criteria for DSEK. The pre-operative evaluation was performed once before the surgery, while post-operative evaluations were conducted at one, three, and six months after the surgical intervention. The main variables assessed in this study encompassed demographic characteristics, visual acuity, surgical techniques, and surgical complications employed during the surgical procedure. The collected data were statistically analyzed using IBM SPSS software version 21 (IBM Corp., Armonk, NY, USA). Patients in the study ranged in age from 25 to 70, with a mean age of 53.16 ± 14.19 years. The participants were 61% male and 39% female. The main reasons for DSEK use were pseudophakic bullous keratopathy (61%) and post-penetrating keratoplasty (PK) graft failure (17%). The other indications were aphakic bullous keratopathy (11%), bullous keratopathy with cataracts (5%), and Fuchs's endothelial dystrophy (5%). The study included 18 eyes: 14 eyes underwent DSEK, two underwent DSEK with small-incision cataract surgery (SICS) and posterior chamber intraocular lens (PCIOL) implantation, and two underwent DSEK with scleral-fixated FIL. A significant improvement in best-corrected visual acuity (BCVA) was observed at six-month follow-up (0.73 ± 0.37 vs. 1.73 ± 0.59 logMAR pre-operatively). During donor cornea dissection, buttonholing was the main concern, occurring 11% of the time. Descemet's perforation and donor preparation thickness variations were also observed. Reverse donor unfolding, incomplete DM stripping, and donor button displacement were quickly addressed and managed. Post-operative graft failure occurred in 22% of cases, while acute graft rejection occurred in 11%. Graft dislocation, pupillary block, and secondary glaucoma each had a 5% prevalence. Descemet's stripping endothelial keratoplasty is a safe and effective treatment for corneal endothelial disorders, particularly in cases where scarring is not present. Surgical skills are essential to achieving the desired results. Descemet's stripping endothelial keratoplasty is favored over conventional keratoplasty for endothelial dysfunction due to its technical advantages and manageable risks. Our research demonstrates a significant improvement in visual acuity through DSEK. Despite manageable post-operative complications, it is vital to educate patients and medical professionals on surgical complexities. Descemet's stripping endothelial keratoplasty appears promising for the treatment of endothelial disorders, but its long-term implications must be studied.

Comparison of Five-Year Graft Survival After Keratoplasty in the Veteran Population

Purpose: We investigated the corneal graft survival rate after penetrating keratoplasty (PK) and Descemet stripping endothelial keratoplasty (DSEK) in a veteran population. Methods: A retrospective review was conducted on patients undergoing a primary PK or DSEK at a large Veterans Affairs Medical Center between January 2005 and August 2019. Exclusion criteria included patients with a postoperative follow-up less than 5 years and patients undergoing additional ocular procedures during surgery. Patients were classified into 3 groups depending on their glaucoma status before corneal transplant: no pre-existing glaucoma, medically managed glaucoma, or surgically managed glaucoma. Graft survival was calculated using the Kaplan–Meier survival analysis. Results: A total of 30 eyes underwent PK, and 28 eyes underwent DSEK. There was no significant difference in graft survival rates between PK and DSEK at 1 year (83% vs. 79%, P = 0.555), 3 years (53% vs. 64%, P = 0.536), and 5 years (40% vs. 54%, P = 0.399). When combining PK and DSEK groups, Kaplan–Meier analysis showed a highly significant difference in 5-year graft survival between patients without pre-existing glaucoma (58%) and patients with either medically (50%) or surgically managed glaucoma (0%). Conclusions: We find approximate parity in 1-year, 3-year, and 5-year survival rates after PK and DSEK within the veteran population. However, survival rates for both procedures are lower than those previously reported within other populations. Additional studies to understand these differences in larger cohorts are warranted. Ophthalmologists must understand the increased risk of graft failure in the veteran population to provide appropriate counseling.

Clinical outcomes of Descemet’s stripping endothelial keratoplasty using a manual or automated procedure at Undaan Eye Hospital Surabaya, Indonesia: with one-year follow up

Background: Endothelial keratoplasty (EK) is a selective lamellar corneal transplantation technique that replaces damaged endothelium while preserving the patient's corneal stroma. Donor graft preparation can be done using Descemet stripping endothelial keratoplasty (DSEK) or Descemet stripping automated endothelial keratoplasty (DSAEK). Research on EK in Indonesia is currently underreported, but it is crucial for developing strategies to treat corneal blindness in the future. This study aimed to present visual acuity, graft survival, and complications after DSEK or DSAEK at Undaan Eye Hospital Surabaya. Methods: This study involved 17 eyes, treated with DSEK or DSAEK surgery between 2017 and 2022. Patients with other ocular diseases and incomplete medical records were excluded. Best corrected visual acuity (BCVA) was documented before the surgery, and at 1 day, 1, 3, 6 months, and 1 year after. Data in this study were analyzed using multiple techniques, including Wilcoxon, Kaplan-Meier survival, and bivariate logistic regression analysis. Results: The postoperative mean BCVA significantly increased to 1.36 ± 0.57 logMAR (p=0.012) at 1 day, 1.02 ± 0.62 logMAR (p=0.002) at 1 month, 0.94 ± 0.66 logMAR (p=0.002) at 3 months, 0.72 ± 0.66 logMAR at 6 months (p=0.000), and 0.74 ± 0.74 logMAR (p=0.001) at 1-year compared to preoperative BCVA of 1.84 ± 0.39 logMAR. The graft could survive 100% within 1 day to 6 months and 76% within 1 year after surgery. Bivariate logistic regression showed donor origin had a statistically significant effect with p-value = 0.031 and odds ratio = 1.8, 95% confidence interval (CI) = 1.003 - 3.229. Corneal edema was the most common complication in the early and late postoperative periods. Conclusion: DSEK or DSAEK surgery is safe, effective, and viable. It shows good visual outcomes and becomes the most used EK treatment for corneal endothelial dysfunction.

Indications and types of keratoplasties: Trends in the past 10 years (2011-2020) in Eastern India.

To observe the trends of various types of keratoplasties in different etiologies over a period of 10 years (2011-2020) in a tertiary eye care center of eastern India. A retrospective review of patients undergoing keratoplasties from 2011 to 2020 was performed in a tertiary eye care hospital situated in eastern part of India. Apart from demographic data, primary indication for each surgery and type of procedure carried out was recorded. For comparison, data were divided into two time periods: Group I: Jan 2011 to Dec 2015 and Group II: Jan 2016 to Dec 2020. Over a period of 10 years, a total of 2365 (Group I: 902, Group II: 1463) keratoplasties were performed. The average age of patients was 45.8 ± 19.9 and 46.9 ± 20.9 years in Group I and Group II, respectively. Among all the corneal grafts, 1747 (74%) surgeries were full-thickness. Although optical penetrating keratoplasty (OPK) was most the common indication for full-thickness keratoplasties, Descemet's stripping endothelial keratoplasty (DSEK) remained most performed lamellar keratoplasty. Keratitis, corneal scars, and bullous keratopathies remain to be most common indications in both groups. Number of lamellar keratoplasties increased significantly from Group I to Group II for corneal scars (P = 0.02), bullous keratopathies (P = 0.01), and endothelial dystrophies (P = 0.00). With change in time, the indication and technique of keratoplasty has witnessed a changing trend from full-thickness keratoplasty to lamellar keratoplasty. There is rise in trend of lamellar keratoplasties over the period.

Suture Fixation to Reduce Graft Detachment in Descemet Stripping Endothelial Keratoplasty.

The aim of this study was to report the outcomes of graft fixation using interrupted, full-thickness sutures on graft detachment after Descemet stripping endothelial keratoplasty (DSEK). All DSEK procedures performed at Mayo Clinic, Rochester, MN, from 2015 through 2022 were retrospectively reviewed. Risk factors for graft detachment were defined as previous incisional glaucoma surgery, previous penetrating keratoplasty, or absence of the normal lens-capsule barrier. Cases were categorized into sutured, high-risk grafts; unsutured, high-risk grafts; and unsutured, low-risk grafts. The primary outcome was graft detachment, and secondary outcomes were early graft failure and graft clarity at 12 months after surgery. Demographics between the high-risk groups were similar for sex and age at the time of surgery. Graft detachment occurred in 4 of 97 sutured, high-risk eyes (4.1%) and 24 of 119 unsutured high-risk eyes (20.2%) ( P = 0.002). In comparison, graft detachment occurred in 18 of 181 unsutured low-risk eyes (9.9%). The incidence of early graft failure was 2.1%, 5.0%, and 3.3% and late graft failure by 12 months was 9.8%, 12.8%, and 4.2%, respectively. In eyes with high-risk factors for graft detachment, suture fixation of the graft in DSEK decreased graft detachment to a rate at least as low as that in low-risk eyes.

Innate Immune Cytokine Levels in Eyes With Late Endothelial Keratoplasty Failure.

The aim of this study was to compare aqueous humor cytokine levels in eyes with an initial endothelial keratoplasty (EK) that cleared and later decompensated versus control eyes. In this prospective case-control study, aqueous humor samples were collected under sterile conditions at the start of planned cataract or EK surgery in normal controls (n = 10), Fuchs dystrophy controls with no previous surgery (n = 10) or previous cataract surgery only (n = 10), eyes with Descemet membrane EK (DMEK) endothelial decompensation (n = 5), and eyes with Descemet stripping EK (DSEK) endothelial decompensation (n = 9). Cytokine levels were quantified with the LUNARIS Human 11-Plex Cytokine Kit and compared using the Kruskal-Wallis nonparametric test and post hoc Wilcoxon pairwise 2-sided multiple comparison test. Levels of granulocyte-macrophage colony-stimulating factor, interferon gamma, interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-10, IL-12p70, and tumor necrosis factorα did not differ significantly between groups. However, IL-6 was significantly increased in DSEK regraft eyes versus controls without previous ocular surgery. IL-8 was significantly increased in eyes with previous cataract or EK surgery versus eyes without previous surgery, and IL-8 was significantly increased in DSEK regraft eyes versus eyes with previous cataract surgery. The levels of innate immune cytokines IL-6 and IL-8 were elevated in the aqueous humor of eyes with failed DSEK, but not with failed DMEK. The differences between DSEK and DMEK may be related to the lower inherent immunogenicity of DMEK grafts and/or the more advanced stage of some of the DSEK graft failures at the time of diagnosis and treatment.