Experience and 12-month results of descemet-stripping endothelial keratoplasty (DSEK) with a small-incision technique.
OBJECTIVE
To report our clinical experience and 12-month results of small-incision Descemet-stripping endothelial keratoplasty (DSEK).


METHODS
Prospective study of 11 eyes of 9 patients who had DSEK. The DSEK technique consisted of stripping the Descemet membrane and endothelium from the recipient cornea. The donor button was prepared by manual dissection and inserted through a 5-mm incision. Air, sulfur hexafluoride (SF6), or perfluoropropane (C3F8) was used both at the end of surgery and in subsequent dislocations to promote donor tissue adherence.


RESULTS
Mean age was 79.6 years (range, 66-91 years), and minimum follow-up was 12 months (range, 12-18 months). Nine eyes had donor tissue dislocation postoperatively, 8 of which received intervention with either SF6 (n = 4) or C3F8 (n = 4). In 1 patient with repeat dislocation, Tisseel glue in combination with C3F8 was used. Preoperative best-corrected visual acuity (BCVA) was 6/24 or worse in all patients. Postoperatively, 6/11 eyes (55%) achieved a BCVA of 6/12 at last follow-up. Mean preoperative cylinder was 1.875 +/- 0.906 D (range, 1-3 D) and postoperatively was 1.5 +/- 1.157 D (range, 0.25-3.25 D). At last follow-up, 6 grafts were clear and 5 had failed. Mean endothelial cell count in the clear grafts at 12-month follow-up was 1078 +/- 507 cells/mm.


CONCLUSIONS
DSEK provided excellent refractive and reasonable visual outcomes in our limited series, but there were frequent problems with dislocation of the donor tissue, and the graft failure rate was high. The graft failures may be linked to excessive endothelial damage, and the high dislocation rate may be linked to not filling the anterior chamber totally with air after insertion of the donor. Further development of the procedure is necessary.
Mearza
Ali A
AA
Moorfields NHS Foundation Trust, Department of Ophthalmology, St. George's Hospital, London, United Kingdom. aL161@yahoo.com
Qureshi
Muhammad A
MA
Rostron
Chad K
CK
D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000637:transplantation*; D005466:Fluorocarbons / Q000008:administration & dosage; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006801:Humans; D019654:Lens Implantation, Intraocular; D008866:Microsurgery; D018918:Phacoemulsification; D011379:Prognosis; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D014792:Visual Acuity / Q000502:physiology
D005466:Fluorocarbons; C042852:perflutren; D013459:Sulfur Hexafluoride