Endothelial keratoplasty: case selection in the learning curve

Area of Science:

• Ophthalmology
• Corneal Surgery
• Transplantation

Background:

• Corneal surgeons are shifting from penetrating keratoplasty to endothelial keratoplasty techniques.
• Descemet's stripping endothelial keratoplasty (DSEK) and Descemet's stripping automated endothelial keratoplasty (DSAEK) are increasingly used for corneal endothelial failure.
• Donor dislocation is a frequent complication of these newer endothelial keratoplasty procedures.

Purpose of the Study:

• To investigate if preoperative lens/iris diaphragm integrity affects donor dislocation rates in endothelial keratoplasty.
• To determine if donor endothelial failure is more prevalent after surgical intervention for donor dislocation.

Main Methods:

• Retrospective multisurgeon comparative case series.
• Analysis of 93 eyes undergoing DSEK or DSAEK between March 2004 and January 2007.
• Review of case notes to assess anterior-posterior chamber communication, donor dislocation requiring intervention, and donor endothelial failure.

Main Results:

• Donor dislocation occurred in 44% of eyes with an open anterior chamber versus 19% with an intact diaphragm (P=0.017).
• Early endothelial failure was significantly more common (29%) in cases requiring surgical intervention for dislocation compared to those without (6%) (P=0.011).
• Data analyzed from 89 eyes with a median follow-up of 7 months.

Conclusions:

• Endothelial keratoplasty donor dislocation is more frequent in eyes with an open anterior chamber.
• Surgical intervention for donor dislocation is associated with an increased risk of donor endothelial failure.
• Surgeons transitioning to endothelial keratoplasty should prioritize cases with an intact lens/iris diaphragm.