title: Graft Detachment Rate in DSEK/DSAEK After Same-Day Complete Air Removal.
abstract: OBJECTIVE
  We retrospectively analyzed the rate of graft detachment from 310 Descemet stripping endothelial keratoplasty (DSEK)/Descemet stripping automated endothelial keratoplasty (DSAEK) cases performed by a single surgeon over a 10-year period using same-day complete air removal. Secondary outcome measures including primary graft failure, late endothelial graft failure, rejection events, and steroid-induced ocular hypertension were also analyzed.
  
  
  METHODS
  A retrospective chart review was performed on all patients receiving DSEK/DSAEK for any cause by the same surgeon at 2 separate institutions from January 2005 to December 2014. The air bubble used to promote graft-host apposition was completely removed after 1 hour. Descriptive statistical analysis was used to report the rates of graft detachment, and χ analysis was used to assess for associations with secondary outcomes.
  
  
  RESULTS
  Among 310 endothelial keratoplasties analyzed, there were 19 graft detachments (6.1%). The graft detachment rate was higher during the learning curve, but rapidly declined with experience, and was 1.3% for the last 79 cases over a 4-year period. No primary graft failures were reported. The rate of steroid-induced ocular hypertension was 20%. The rate of graft failure was 8%. The rate of graft rejection events was 10.7%. Two of the 6 patients (33%) who underwent trabeculectomy before endothelial keratoplasty suffered a detachment.
  
  
  CONCLUSIONS
  A graft detachment rate as low as 1.3% can be achieved in DSEK/DSAEK with same-day complete air removal shortly after surgery. Factors believed to contribute to a low detachment rate include complete interface fluid removal and reconstitution of the normal anterior chamber milieu to assist corneal endothelial function.
authors.affiliation: Departments of Ophthalmology, *Baylor Scott and White Hospital, Temple, TX; and †Central Texas Veterans Administration, Temple, TX.
authors.forename: Roy E
authors.initials: RE
authors.lastname: Lehman
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Stock
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Fulcher
mesh_terms: D000388:Air; D000959:Antihypertensive Agents / Q000627:therapeutic use; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D058450:Endotamponade; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D059032:Learning Curve; D009798:Ocular Hypertension / Q000209:etiology / Q000628:therapy; D018918:Phacoemulsification; D011183:Postoperative Complications; D012189:Retrospective Studies; D014130:Trabeculectomy
chemical_list: D000959:Antihypertensive Agents