Complications of Descemet's stripping with automated endothelial keratoplasty: survey of 118 eyes at One Institute.
OBJECTIVE
To compile a survey of complications during and after Descemet's stripping with automated endothelial keratoplasty (DSAEK) in 118 eyes conducted by cornea subspecialists at a single academic center.


METHODS
Retrospective case series.


METHODS
One hundred eighteen eyes undergoing DSAEK in 99 patients.


METHODS
Outcomes of DSAEK performed in 118 eyes by 10 surgeons were reviewed retrospectively. Sixty-four eyes had pseudophakic bullous keratopathy. Forty-one had Fuchs' endothelial dystrophy and cataract. Three had aphakic bullous keratopathy. In 10 eyes, previous DSAEK performed at the same institution failed. Complications of DSAEK were noted from the intraoperative and postoperative periods. Detached DSAEK grafts were repositioned, rebubbled, or both immediately after diagnosis of this complication.


METHODS
Intraoperative and postoperative complications of DSAEK.


RESULTS
Graft detachment was the most common type of complication encountered. In 27 (23%) of 118 eyes, graft detachments were observed. Twenty-five eyes with detached grafts successfully were repositioned or rebubbled after surgery, or both. In 1 eye, a previously detached graft reattached spontaneously. In 1 aphakic eye, the graft detached into the vitreous cavity. In 17 eyes, successful reattachment of the cornea occurred (68%). Twenty-one of the 118 eyes were considered to have failed DSAEK, meaning that persistent edema was present after DSAEK. Seven (6%) demonstrated graft rejection. In 5 eyes (4%), retinal detachment (RD) developed. In 6 (5%), cystoid macular edema developed. In 1 aphakic patient, an air bubble could not be maintained during surgery, and sulfur hexafluoride was injected into the anterior chamber. In 1 eye (1%), epithelial ingrowth developed. One eye (1%) demonstrated blood in the graft interface. In 1 eye (1%), a limited intraoperative suprachoroidal hemorrhage occurred. Two eyes (2%) had pupillary block after surgery that resolved with removal of the air bubble.


CONCLUSIONS
Descemet's stripping with automated endothelial keratoplasty has become a popular and effective treatment for corneal endothelial dysfunction, but complications resulting from DSAEK do occur. Graft detachment is the most common complication, but postoperative repositioning or rebubbling, or both, allow for graft reattachment in most cases. Other complications found in this series were graft failure, graft rejection, cystoid macular edema, RD, suprachoroidal hemorrhage, and pupillary block. Retained Descemet's membrane and epithelial ingrowth, are potential causes of dislocation.
Suh
Leejee H
LH
Division of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miami, Florida 33418, USA.
Yoo
Sonia H
SH
Deobhakta
Avnish
A
Donaldson
Kendall E
KE
Alfonso
Eduardo C
EC
Culbertson
William W
WW
O'Brien
Terrence P
TP
D000867:Anterior Chamber / Q000473:pathology; D003316:Corneal Diseases / Q000601:surgery; D016039:Corneal Transplantation; D003886:Descemet Membrane / Q000473:pathology / Q000601:surgery*; D004728:Endothelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D006085:Graft Survival; D006306:Health Surveys; D006801:Humans; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D008297:Male; D018918:Phacoemulsification; D011183:Postoperative Complications; D012189:Retrospective Studies; D012827:Silicone Oils / Q000008:administration & dosage; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D041623:Tomography, Optical Coherence
D012827:Silicone Oils; D013459:Sulfur Hexafluoride