title: Retrospective review of graft dislocation rate associated with descemet stripping automated endothelial keratoplasty after primary failed penetrating keratoplasty.
abstract: OBJECTIVE
  To report the rate of graft dislocation in patients who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) after a previous penetrating keratoplasty (PKP).
  
  
  METHODS
  Institutional review board-approved, multicenter, retrospective chart review. Inclusion criteria included: prior failed PKP and subsequent DSAEK. The primary outcomes measured in this study were the presence of a graft dislocation, rate of rebubble, and graft attachment. Additional variables included: presence of a prior glaucoma drainage device, graft-to-host size disparity, number of sutures remaining in PKP, and stripping of the Descemet membrane at the time of DSAEK surgery.
  
  
  RESULTS
  Ninety patients (97 eyes) were included in the study. In 31% (30 of 97), the endothelial graft dislocated after surgery. All 30 cases required a rebubble except 1, which reattached spontaneously. Ninety-eight percent (95 of 97) of all grafts remained attached for the duration of the follow-up period. Only 2 eyes (2.2%) required repeat graft. Endothelial grafts dislocated in 67% of patients with glaucoma draining devices. The dislocation rate for grafts larger than the host was 12 of 49 (24%), equal to the host was 3 of 17 (18%), and smaller than the host was 8 of 19 (42%). Dislocations occurred in 5 of 21 (24%) of grafts with sutures remaining and 22 of 76 (29%) of those with all sutures out. Five of 12 (42%) cases of grafts performed without stripping the Descemet had dislocations.
  
  
  CONCLUSIONS
  The graft dislocation rate in DSAEK procedures after PKP is comparable to that after primary DSAEK cases. Donor grafts that are smaller than the host PKP and the presence of prior glaucoma drainage devices are risk factors for higher rates of graft dislocation.
authors.affiliation: Department of Ophthalmology, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Clements
authors.forename: Charles S
authors.initials: CS
authors.lastname: Bouchard
authors.forename: W Barry
authors.initials: WB
authors.lastname: Lee
authors.forename: Steven P
authors.initials: SP
authors.lastname: Dunn
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Mannis
authors.forename: James J
authors.initials: JJ
authors.lastname: Reidy
authors.forename: Thomas
authors.initials: T
authors.lastname: John
authors.forename: Sadeer B
authors.initials: SB
authors.lastname: Hannush
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Goins
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wagoner
authors.forename: Marwa A
authors.initials: MA
authors.lastname: Adi
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Rubenstein
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Udell
authors.forename: Amy S
authors.initials: AS
authors.lastname: Babiuch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology* / Q000637:transplantation; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D005901:Glaucoma / Q000150:complications; D006084:Graft Rejection / Q000209:etiology*; D006801:Humans; D007640:Keratoconus / Q000601:surgery; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012164:Retinal Diseases / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D014792:Visual Acuity / Q000502:physiology