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Clinical Evaluation of Non Descemet-Stripping Automated Endothelial Keratoplasty

Background. Descemet's stripping endothelial keratoplasty (DSAEK) has been a revolutionary change in the treatment of endothelial disorders, aviding the need for the more invasive penetrating keratoplasty.Recently, we eliminated Descemet stripping for non-Fuchs type bullous keratopathies and called

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Clinical Evaluation of Non Descemet-Stripping Automated Endothelial Keratoplasty

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    1. Clinical Evaluation of Non Descemet-Stripping Automated Endothelial Keratoplasty Akira Kobayashi MD, PhD, Hideaki Yokogawa MD, Kazuhisa Sugiyama MD, PhD, Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.

    2. Background

    3. Purpose To report clinical outcomes of non-Descemet’s stripping automated endothelial keratoplasty (nDSAEK) as treatment for non-Fuchs type endothelial dysfunction.

    4. Methods Ten eyes (ten patients, three men, seven women; mean age, 73.5±6.6 years [mean±SD]) with bullous keratopathy were treated with endothelial keratoplasty “without recipient Descemet’s stripping”(nDSAEK). Nine patients had previous argon laser iridotomy for angle closure glaucoma attack; the remaining patient had developed bullous keratopathy after endotheliitis. Best corrected visual acuity (BCVA), astigmatism and donor central endothelial cell density (ECD) were recorded preoperatively and at six months postoperatively. Intra- and postoperative complications were also recorded.

    6. Double-glide technique (The video is downloadable from AJO.com 1)

    7. Results 1 Visual Acuity All ten patients (100%) reached better than 20/32 BCVA within six months after nDSAEK. Four patients (40.0%) reached more than 20/20, and one patient (10.0%) reached 20/16 within six months. Within one year, seven patients (70.0%) reached more than 20/20, and two (20.0%) reached 20/16. Astingmatism Mean induced astigmatism in measurable cases at six months postoperatively was 0.67D?0.45D (range, 0.25D to 1.5D).

    8. Results 2 Complications Postoperatively, one patient experienced donor dislocation requiring re-bubbling. Endothelial cell counts Postoperative ECD after six months ranged from 1589 to 3095 cells/mm2 (mean, 2229.4?501.0 cells/mm2), a 26.5% reduction compared with donor counts (mean, 3034.5?356.9 cells/mm2).

    10. Summary minimal induced astigmatism (0.67D±0.45D ). excellent visual acuity (seven patients (70.0%) reached better than 20/20, and two patients (20.0%) reached 20/16. ) less endothelial cell loss (26.5% reduction after 6 months) using double-glide technique, which is extremely useful for narrow angle eyes such as Asian eyes.

    11. Conclusions This modified endothelial keratoplasty technique (nDSAEK) for treatment of non-Fuchs type endothelial dysfunction produced excellent clinical outcomes such as reduced endothelial cell loss, good visual acuity and minimal induced astigmatism. Further studies using a large number of patients and with long-term follow-up after nDSAEK are needed to fully understand the benefits of this procedure.

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