ABSTRACT
AIM: To investigate the impact of non-Descemet stripping endothelial keratoplasty (non-DSEK) on graft rejection rate, and its overall procedural effectiveness in patients. METHODS: Non-DSEK was performed on 65 eyes of 64 patients, and the procedural outcomes, including rejection episodes, failure and dislocation of the grafts, best corrected visual acuity (BCVA), endothelial cell density (ECD), and other complications, were analyzed retrospectively. RESULTS: Of the 65 eyes, 63 recovered from bullous keratopathy with a clear cornea. The mean follow-up time was 26.4mo (range, 6-84mo). The mean BCVA improved from 1.70 logMAR preoperatively to 0.54 logMAR at 3mo, 0.46 logMAR at 6mo, and 0.37 logMAR at 1y after surgery. The postoperative donor ECD of the 25 patients who successfully underwent specular microscopic examination was 1918±534 cells/mm2 (range, 637 to 3056 cells/mm2), and the mean endothelial cell loss was 41.9% at 24mo postoperatively. One eye developed secondary glaucoma and required regrafting via penetrating keratoplasty (PKP). Another eye had postoperative graft failure due to rejection at 26mo. Postoperative graft dislocation occurred in eight eyes. All of the eight dislocated grafts were reattached using air reinjection. CONCLUSION: Immunological graft rejection of the donor graft rarely occurs in non-DSEK. Therefore, non-DSEK is a safe, concise, and effective alternative to restore corneal decompensation when the Descemet membrane is disease-free.
ABSTRACT
OBJECTIVE: To report clinical results of non-Descemet stripping automated endothelial keratoplasty (nDSAEK) to treat graft failure after penetrating keratoplasty. METHODS: It was a retrospective case series study. Five cases of grafts failure after penetrating keratoplasty (PKP) were enrolled in this study. All patients had a cloudy and swollen grafts, which thicker than 620 µm, and had foreign body sensation, vision decrease. Of this 5 cases, 4 of them are pseudophakic eye, 1 is aphakic eye. One patient had previous vitrectomy, and 3 of them had one time history of PKP, 2 of them had twice PKP treatment. All cases were treated by nDSAEK, the nDSAEK grafts were prepared as a 200 µm thickness and 8.00 to 8.75 mm in diameter by using hand or femtosecond laser assisted methods. The graft was inserted by forceps or suture pulling method through a 5.00 mm scleral tunel incision. RESULTS: One graft dislocated at 1day postoperation, and was reattached by rebuble. All grafts keep clear during 8 - 28 months follow up period, and no immune rejection episodes were noted. The endothelial density were 865 to 2410/mm(2). Postoperative best corrected vision (pBCVA) are better or equal to previous BCVA after pkp. CONCLUSION: nDSAEK appears a good alternative surgical method for patients of grafts failure after pkp, especially for high risk patients of immune rejection.
