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Descemet Stripping Endothelial Keratoplasty (DSAEK) Following Penetrating Keratoplasty (PK)

Descemet Stripping Endothelial Keratoplasty (DSAEK) Following Penetrating Keratoplasty (PK). Amit Patel, FRCOphth Massimo Busin, MD Villa Serena Hospital, Forli’, Italy Fondazione Banca degli Occhi del Veneto, Venice, Italy

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Descemet Stripping Endothelial Keratoplasty (DSAEK) Following Penetrating Keratoplasty (PK)

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  1. Descemet Stripping Endothelial Keratoplasty (DSAEK)Following Penetrating Keratoplasty (PK) Amit Patel, FRCOphth Massimo Busin, MD Villa Serena Hospital, Forli’, Italy Fondazione Banca degli Occhi del Veneto, Venice, Italy ------------------------------------------------------------------------------------------------------------ Financial Disclosure Pfizer (UK) Ophthalmic Fellowship Award (AP) Travel reimbursements and royalties from Moria, Antony, France (MB)

  2. PURPOSE • To Evaluate the Outcomes of DSAEK in Eyes With Post-Penetrating Keratoplasty (PK) Endothelial Decompensation.

  3. METHODS • Prospective Study • January 2007 to June 2009 • Cause of Endothelial Failure • UCVA, BCVA, ECC noted at 1, 3, 6, 12 and 24 months post-DSAEK • Complications

  4. SURGICAL TECHNIQUE • Descemetorhexis Within PK wound and Peripheral Iridotomy • Graft Delivery with Busin Glide Through a 3.2mm Clear-Corneal Tunnel

  5. SURGICAL TECHNIQUE • 8.5 to 9.0mm Donor Button(arrows) Centered on the Limbus Regardless of the PK Wound • Air Fill to Achieve Graft Attachment & Air-tight Suturing of All Wounds

  6. RESULTS • 31 Cases Recruited • 29/31 Immunologic Graft Failure • All DSAEK Grafts Larger than Original PK(8.5-9.0 mm vs 7.5-8.0 mm)

  7. RESULTS • All Grafts Attached (1 case Required Re-bubbling) • Average Follow up 9.8 Months (Range 3-24 Months) • ECL at 1 year = 27.5% [16/31 eyes] • No Graft Failures at Last Follow up

  8. RESULTS • Visual Outcomes • Pre-op BCVA <20/200 in 30/31 cases • Post-op BCVA • Improved in 25/31 cases • Unchanged in 6/31 cases

  9. RESULTS • Complications • 1 Graft Detachment on 1st Postoperative Day (Successful Attachment with Re-bubbling) • 1 PK Wound Dehiscence (sutured ) • 1 Immunologic Graft Rejection (Treated Successfully)

  10. CONCLUSIONS • DSAEK is Effective in Treating Post PK Endothelial Failure • 2-Year Success Rate is High in Eyes with High Risk of Rejection in spite of a Diameter Larger than that of the Original PK

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