title: Three-millimeter incision descemet stripping endothelial keratoplasty using sodium hyaluronate (healon): a survey of 105 eyes.
abstract: OBJECTIVE
  To report a Descemet stripping automated endothelial keratoplasty (DSAEK) insertion technique using sodium hyaluronate (Healon) and describe complication rates, visual acuity, and endothelial cell counts.
  
  
  METHODS
  A retrospective analysis of 105 eyes in 91 patients undergoing DSAEK. Ninety-three eyes had Fuchs endothelial dystrophy, 11 had bullous keratopathy, and 1 had iridocorneal endothelial (ICE) syndrome. We noted pre- and postoperative visual acuity at 3 and 6 months, endothelial cell counts, and complications, including graft detachment rates. Thirty-six of 141 eyes met exclusion criteria of prior incisional corneal, glaucoma, or retinal surgery.
  
  
  RESULTS
  Because of graft detachment, 29 of 105 eyes (28%) required a re-bubble procedure at day 1 or week 1. Five of 105 grafts (4.8%) failed. Of note, in the last 35 cases, there were no graft failures and 5 detachments (14%). Twenty-eight percent of patients were 20/40 or better preoperatively compared with 49% at 3 months and 52% at 6 months. Excluding eyes with other ocular comorbidities (34), 62% were 20/40 or better at 3 months and 72% were 20/40 or better at 6 months. Postoperative endothelial cell counts were available for 52 eyes with an average cell loss of 44% at an average of 9.4 months.
  
  
  CONCLUSIONS
  DSAEK is an effective treatment for endothelial dysfunction, but the learning curve is steep. Anterior chamber stability, graft positioning, and small incision insertion are advantages to our technique. Disadvantages include a relatively high endothelial loss and dislocation rate. Minimizing endothelial cell loss and graft dislocation continue to be important goals for successful DSAEK.
authors.affiliation: Wake Forest University Eye Center, Winston-Salem, NC, USA.
authors.forename: J Brian
authors.initials: JB
authors.lastname: Foster
authors.forename: Ryan
authors.initials: R
authors.lastname: Vasan
authors.forename: Keith A
authors.initials: KA
authors.lastname: Walter
mesh_terms: D000368:Aged; D001768:Blister / Q000601:surgery*; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D057129:Iridocorneal Endothelial Syndrome / Q000601:surgery*; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors; D014792:Visual Acuity
chemical_list: D006820:Hyaluronic Acid