Tuesday, January 27, 2009
Dr. Suh outlines her recent publication on DSEK complications -- Complications of Descemet's stripping with automated endothelial keratoplasty: survey of 118 eyes at One Institute.
Most common complication is dislocations, but re-bubbling or repositioning the graft is a viable option. Even so, a significant number of the relocated grafts fail (stay edematous). One of the factors in graft failure is the loss of endothelial cells. Other complications, cystoid macular edema, retinal detachment (if previous procedures had been done), suprachoroidal hemorrhage, epithelial ingrowth, graft rejection (most of which resolved with medical treatment). In one aphakic patient, one day post-op, the surgeons were unable to find the graft, but on ultrasound it was found in the posterior pole.
DSEK hints: Graft insertion has to be as atraumatic as possible so limit the manipulation. Pupillary block is always a risk so keep a large air bubble to keep the graft attached for the first ten minutes then reduce. Use of cycloplegics may also be a good idea whereas some choose peripheral iridotomy. Graft insertion innovations will be the main thing driving success rates. Even with the complications listed, most of which can be corrected, DSEK is still a better approach that full thickness PK. Everyone is looking forward to long term data on endothelial cell counts in these grafts.