Retrospective review of graft dislocation rate associated with descemet stripping automated endothelial keratoplasty after primary failed penetrating keratoplasty

John Clements, Charles S. Bouchard, W. Barry Lee, Steven P. Dunn, Mark J. Mannis, James J. Reidy, Thomas John, Sadeer B. Hannush, Kenneth M. Goins, Michael D. Wagoner, Marwa A. Adi, Jonathan B. Rubenstein, Ira J. Udell, Amy S. Babiuch

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Purpose: To report the rate of graft dislocation in patients who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) after a previous penetrating keratoplasty (PKP). Methods: Institutional review board-approved, multicenter, retrospective chart review. Inclusion criteria included: prior failed PKP and subsequent DSAEK. The primary outcomes measured in this study were the presence of a graft dislocation, rate of rebubble, and graft attachment. Additional variables included: presence of a prior glaucoma drainage device, graft-to-host size disparity, number of sutures remaining in PKP, and stripping of the Descemet membrane at the time of DSAEK surgery. Results: Ninety patients (97 eyes) were included in the study. In 31% (30 of 97), the endothelial graft dislocated after surgery. All 30 cases required a rebubble except 1, which reattached spontaneously. Ninety-eight percent (95 of 97) of all grafts remained attached for the duration of the follow-up period. Only 2 eyes (2.2%) required repeat graft. Endothelial grafts dislocated in 67% of patients with glaucoma draining devices. The dislocation rate for grafts larger than the host was 12 of 49 (24%), equal to the host was 3 of 17 (18%), and smaller than the host was 8 of 19 (42%). Dislocations occurred in 5 of 21 (24%) of grafts with sutures remaining and 22 of 76 (29%) of those with all sutures out. Five of 12 (42%) cases of grafts performed without stripping the Descemet had dislocations. Conclusions: The graft dislocation rate in DSAEK procedures after PKP is comparable to that after primary DSAEK cases. Donor grafts that are smaller than the host PKP and the presence of prior glaucoma drainage devices are risk factors for higher rates of graft dislocation.

Original languageEnglish (US)
Pages (from-to)414-418
Number of pages5
JournalCornea
Volume30
Issue number4
DOIs
StatePublished - Apr 2011
Externally publishedYes

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Descemet Stripping Endothelial Keratoplasty
Penetrating Keratoplasty
Transplants
Glaucoma
Sutures
Equipment and Supplies
Drainage
Descemet Membrane
Research Ethics Committees

Keywords

  • Cornea transplant
  • Descemet stripping endothelial keratoplasty
  • endothelial keratoplasty
  • penetrating keratoplasty

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Retrospective review of graft dislocation rate associated with descemet stripping automated endothelial keratoplasty after primary failed penetrating keratoplasty. / Clements, John; Bouchard, Charles S.; Lee, W. Barry; Dunn, Steven P.; Mannis, Mark J.; Reidy, James J.; John, Thomas; Hannush, Sadeer B.; Goins, Kenneth M.; Wagoner, Michael D.; Adi, Marwa A.; Rubenstein, Jonathan B.; Udell, Ira J.; Babiuch, Amy S.

In: Cornea, Vol. 30, No. 4, 04.2011, p. 414-418.

Research output: Contribution to journalArticle

Clements, J, Bouchard, CS, Lee, WB, Dunn, SP, Mannis, MJ, Reidy, JJ, John, T, Hannush, SB, Goins, KM, Wagoner, MD, Adi, MA, Rubenstein, JB, Udell, IJ & Babiuch, AS 2011, 'Retrospective review of graft dislocation rate associated with descemet stripping automated endothelial keratoplasty after primary failed penetrating keratoplasty', Cornea, vol. 30, no. 4, pp. 414-418. https://doi.org/10.1097/ICO.0b013e3181f7f163
Clements, John ; Bouchard, Charles S. ; Lee, W. Barry ; Dunn, Steven P. ; Mannis, Mark J. ; Reidy, James J. ; John, Thomas ; Hannush, Sadeer B. ; Goins, Kenneth M. ; Wagoner, Michael D. ; Adi, Marwa A. ; Rubenstein, Jonathan B. ; Udell, Ira J. ; Babiuch, Amy S. / Retrospective review of graft dislocation rate associated with descemet stripping automated endothelial keratoplasty after primary failed penetrating keratoplasty. In: Cornea. 2011 ; Vol. 30, No. 4. pp. 414-418.
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abstract = "Purpose: To report the rate of graft dislocation in patients who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) after a previous penetrating keratoplasty (PKP). Methods: Institutional review board-approved, multicenter, retrospective chart review. Inclusion criteria included: prior failed PKP and subsequent DSAEK. The primary outcomes measured in this study were the presence of a graft dislocation, rate of rebubble, and graft attachment. Additional variables included: presence of a prior glaucoma drainage device, graft-to-host size disparity, number of sutures remaining in PKP, and stripping of the Descemet membrane at the time of DSAEK surgery. Results: Ninety patients (97 eyes) were included in the study. In 31{\%} (30 of 97), the endothelial graft dislocated after surgery. All 30 cases required a rebubble except 1, which reattached spontaneously. Ninety-eight percent (95 of 97) of all grafts remained attached for the duration of the follow-up period. Only 2 eyes (2.2{\%}) required repeat graft. Endothelial grafts dislocated in 67{\%} of patients with glaucoma draining devices. The dislocation rate for grafts larger than the host was 12 of 49 (24{\%}), equal to the host was 3 of 17 (18{\%}), and smaller than the host was 8 of 19 (42{\%}). Dislocations occurred in 5 of 21 (24{\%}) of grafts with sutures remaining and 22 of 76 (29{\%}) of those with all sutures out. Five of 12 (42{\%}) cases of grafts performed without stripping the Descemet had dislocations. Conclusions: The graft dislocation rate in DSAEK procedures after PKP is comparable to that after primary DSAEK cases. Donor grafts that are smaller than the host PKP and the presence of prior glaucoma drainage devices are risk factors for higher rates of graft dislocation.",
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AU - Clements, John

AU - Bouchard, Charles S.

AU - Lee, W. Barry

AU - Dunn, Steven P.

AU - Mannis, Mark J.

AU - Reidy, James J.

AU - John, Thomas

AU - Hannush, Sadeer B.

AU - Goins, Kenneth M.

AU - Wagoner, Michael D.

AU - Adi, Marwa A.

AU - Rubenstein, Jonathan B.

AU - Udell, Ira J.

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N2 - Purpose: To report the rate of graft dislocation in patients who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) after a previous penetrating keratoplasty (PKP). Methods: Institutional review board-approved, multicenter, retrospective chart review. Inclusion criteria included: prior failed PKP and subsequent DSAEK. The primary outcomes measured in this study were the presence of a graft dislocation, rate of rebubble, and graft attachment. Additional variables included: presence of a prior glaucoma drainage device, graft-to-host size disparity, number of sutures remaining in PKP, and stripping of the Descemet membrane at the time of DSAEK surgery. Results: Ninety patients (97 eyes) were included in the study. In 31% (30 of 97), the endothelial graft dislocated after surgery. All 30 cases required a rebubble except 1, which reattached spontaneously. Ninety-eight percent (95 of 97) of all grafts remained attached for the duration of the follow-up period. Only 2 eyes (2.2%) required repeat graft. Endothelial grafts dislocated in 67% of patients with glaucoma draining devices. The dislocation rate for grafts larger than the host was 12 of 49 (24%), equal to the host was 3 of 17 (18%), and smaller than the host was 8 of 19 (42%). Dislocations occurred in 5 of 21 (24%) of grafts with sutures remaining and 22 of 76 (29%) of those with all sutures out. Five of 12 (42%) cases of grafts performed without stripping the Descemet had dislocations. Conclusions: The graft dislocation rate in DSAEK procedures after PKP is comparable to that after primary DSAEK cases. Donor grafts that are smaller than the host PKP and the presence of prior glaucoma drainage devices are risk factors for higher rates of graft dislocation.

AB - Purpose: To report the rate of graft dislocation in patients who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) after a previous penetrating keratoplasty (PKP). Methods: Institutional review board-approved, multicenter, retrospective chart review. Inclusion criteria included: prior failed PKP and subsequent DSAEK. The primary outcomes measured in this study were the presence of a graft dislocation, rate of rebubble, and graft attachment. Additional variables included: presence of a prior glaucoma drainage device, graft-to-host size disparity, number of sutures remaining in PKP, and stripping of the Descemet membrane at the time of DSAEK surgery. Results: Ninety patients (97 eyes) were included in the study. In 31% (30 of 97), the endothelial graft dislocated after surgery. All 30 cases required a rebubble except 1, which reattached spontaneously. Ninety-eight percent (95 of 97) of all grafts remained attached for the duration of the follow-up period. Only 2 eyes (2.2%) required repeat graft. Endothelial grafts dislocated in 67% of patients with glaucoma draining devices. The dislocation rate for grafts larger than the host was 12 of 49 (24%), equal to the host was 3 of 17 (18%), and smaller than the host was 8 of 19 (42%). Dislocations occurred in 5 of 21 (24%) of grafts with sutures remaining and 22 of 76 (29%) of those with all sutures out. Five of 12 (42%) cases of grafts performed without stripping the Descemet had dislocations. Conclusions: The graft dislocation rate in DSAEK procedures after PKP is comparable to that after primary DSAEK cases. Donor grafts that are smaller than the host PKP and the presence of prior glaucoma drainage devices are risk factors for higher rates of graft dislocation.

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