DSEK for the treatment of endothelial disease in India

-Initial Experience in 80 eyes-

Authors have no financial interest

Dr Ashish Nagpal MD, FRCS

Dr Sandeep Arora MD, FRCS

Cornea and External Disease Services,Retina Foundation,

Ahmedabad, Gujarat, INDIAwww.retinafoundation.com

Authors have no financial interest

PURPOSE

To evaluate clinical experience and outcome of Descemet’s Stripping Endothelial Keratoplasty (DSEK) in Indian patients

with primary or secondary endothelial decompensation.

Study Design : Retrospective Non comparative Surgical Case Series

Study Period: October 2006 and November 2009

METHODS

• DSEK was performed in 80 eyes of 76 patients with endothelial decompensation .

Indications

Pseudophakic Bullous Keratopathy

54

Fuchs' Dystrophy 20

Failed corneal graft 4

ICE Syndrome 2

Post Viral Endothelitis Decompensation

4

OBSERVATIONS

Demographic Data

Age 65.43 years (range 21 – 78 years)

Sex Males: Females

Mean Follow up

18 months ( 4 to 36 months)

All patients underwent a standard DSEK as shown in video. (also available on youtube – search drashishnagpal)

In 18 cases phacoemulsification with implantation of an intraocular lens into the capsular bag was combined with DSEK surgery.

Visual acuity, refraction and endothelial cell count were evaluated prospectively at 1, 3, 6, and 12, 18 ,24 , 30 months after DSEK.

Preoperative, Surgical and Post operative data

Eyes

Recipient preoperative lens statusPseudophakic Phakic

6020

Procedures combined with DSEKPhacoemulsification with IOL implantationManual SICS with IOL implant IOL exchange/Scleral Fixated IOLEpithelial removal Superficial Keratectomy

1811

7701

Postoperative surgical proceduresDonor tissue reposition / rebubblingDSEK for primary donor failure PKP for primary donor failure PKP for secondary graft failure

3212

OBSERVATIONS & RESULTS

Main Outcome Measures

Improvement in Corneal Clarity

74 of 80

Graft Attachment 75 of 80

Best Spectacle Corrected Visual Acuity

68 eyes had better than 6/12

OBSERVATIONS & RESULTS

Secondary Outcome Measures

Refraction 79 of 80 had less than 2 D of astigmatism

Endothelial Cell Count

33.2 % (+ 12 .5 %)

Perioperative Complications

Main Outcome Measures

Improvement in Corneal Clarity

74 of 80 eyes

OBSERVATIONS & RESULTS

Cause for no Improvement in Corneal Clarity in 6 eyes

Iatrogenic Failure 4 eyes

Endophthalmitis 1 eye

ICE syndrome 1 eye

OBSERVATIONS & RESULTS

Main Outcome Measures

Graft Attachment 75 of 80 eyes

Type of non attachment in 5 eyes

Partial Detachment 2 eyes

Total Detachment 3 eyes

In 3 eyes it was managed successfully with single rebubbling, while 2 eyes had to undergo re DSEK / Keratoplasty due to repeated bubblings and non attachment

OBSERVATIONS & RESULTS

Main Outcome Measures

Best Spectacle Corrected Visual Acuity

68 eyes had better than 6/12

Reason for Limited Vision in 12 eyes

CME ( Cystoid macular Oedema)

4 eyes

Glaucoma 3 eyes

Macular Degeneration

3 eyes

Anterior Stromal Scar

2 eyes

OBSERVATIONS & RESULTS

Secondary Outcome Measures

Refraction 79 of 80 had less than 2 D of astigmatism

Endothelial Cell Count

33.2 % (+ 12 .5 %)

3 months

1364/cmm2

23months

1297/cmm2

Endothelial Cell Count Attrition rate varied from 20.7 % to 45.7 % from 3 months to 24 months

4 months

1388/cmm2

26 months

744/cmm2

Other Peri and Post operative Complications

Thick Donor 2

Pupillary Block 2

Interface haze 2

Interface bleeding

1

Graft Rejection 3

Glaucoma 2

OBSERVATIONS & RESULTS

CONCLUSIONDESCEMET’S STRIPPING ENDOTHELIAL KERATOPLASTY (DSEK) surgery allows fast visual rehabilitation of Indian patients with decompensated endothelium as compared to penetrating Keratoplasty. Endothelial cell loss and dislocations were more in the initial learning curve of DSEK.