Experienced DSAEK Surgeon's Transition to DMEK: Outcomes Comparing the Last 100 DSAEK Surgeries With the First 100 DMEK Surgeries Exclusively Using Previously Published Techniques.

PURPOSE: To compare outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) when an experienced DSAEK surgeon transitions to DMEK while following 2 published endothelial keratoplasty surgical techniques. METHODS: This is a retrospective review of 200 eyes of 132 patients with Fuchs corneal dystrophy that underwent endothelial keratoplasty performed by one surgeon. Published, standardized techniques were followed for both DSAEK and DMEK. Postoperative complications were recorded. Best spectacle-corrected visual acuity (BSCVA), intraocular pressure, and central endothelial cell loss (ECL) were evaluated at 6 months postoperatively. RESULTS: There were no intraoperative complications. One DSAEK and 5 DMEK grafts developed graft detachment requiring rebubbling (P = 0.097). No iatrogenic primary graft failures occurred in the DSAEK group compared with one in the DMEK group. No pupil block episodes occurred in the DSAEK group compared with one in the DMEK group. Posterior synechiae formation occurred 15 times in the DMEK group and did not occur in the DSAEK group (P < 0.001). At 6 months, BSCVA was better in the DMEK group than in the DSAEK group (20/24; logMAR = 0.0844-20/32; logMAR = 0.2063) (P < 0.001). More eyes reached 20/20 or better BSCVA in the DMEK group compared with DSAEK (54.5%-13%) (P < 0.011). At 6 months, ECL was higher in the DMEK group than in the DSAEK group (31.9%-19.9%) (P < 0.001). CONCLUSIONS: Complications can be minimized and excellent outcomes can be achieved, without a steep learning curve, when an experienced DSAEK surgeon transitions to DMEK following a standardized technique. Six-month vision outcomes are better in the DMEK group; however, the rate of a newly described complication, posterior synechiae formation, and 6-month ECL are higher in the DMEK group than in the DSAEK group.

Preoperative graft thickness measurements do not influence final BSCVA or speed of vision recovery after descemet stripping automated endothelial keratoplasty.

PURPOSE: To evaluate the influence of preoperative graft thickness (GT) on final visual acuity and speed of vision recovery after Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: The best spectacle-corrected acuity (BSCVA) was measured after DSAEK was performed at 1, 3, 6, 12, and 24 months. A regression analysis was performed to determine whether GT predicted the BSCVA across each time gate. The time to achieve the "1-year maximum BSCVA" was determined to assess the "speed" of recovery for all eyes that had data at 1, 3, 6, and 12 months. Additionally, the final BSCVA was compared between 2 distinct groups of "thin" (<125-µm) versus "thick" (>165-µm) tissue. RESULTS: There were 144 eyes evaluated. No significant correlations were found between the GT and the BSCVA at any of the time gates: 1, 3, 6, 12, or 24 months. Speed of vision recovery was not affected by the GT. The average GT values of the eyes that achieved BSCVA by 1, 3, 6 months and 1 year were not significantly different and were 154.7, 141.3, 149, and 150.1 µm, respectively. No difference was found between the BSCVA of "thick" versus "thin" tissues at any of the time gates: 1, 3, 6, or 12 months. CONCLUSIONS: Preoperative GT measurements were not correlated with the BSCVA after the DSAEK was performed at 1, 6, 12, or 24 months postoperatively and do not determine the speed of vision recovery. Additionally, no difference was found in postoperative vision outcomes when directly comparing tissues at either end of the GT spectrum of this study.

Descemet stripping endothelial keratoplasty: six-month results of the first 100 consecutive surgeries performed solo by a surgeon using 1 technique with 100% follow-up.

PURPOSE: To determine the outcomes and complication rates achieved by a novice cornea surgeon when performing Descemet stripping automated endothelial keratoplasty (DSAEK) while precisely following a previously described forceps insertion technique. METHODS: Prospective, noncomparative interventional case series including 100 eyes of 74 patients with endothelial decompensation. An institutional review board approved, prospective, DSAEK series was initiated. Cases included all initial patients with endothelial failure operated on by a single surgeon after his cornea fellowship training. The surgeon strictly adhered to a previously published 5-mm incision, folded forceps graft insertion technique. Patients were followed at 1 day, 1 week, and 1, 3, and 6 months. Postoperative complications (including graft dislocation, primary graft failure, and pupillary block), best spectacle-corrected visual acuity (BSCVA) and specular microscopy of central endothelial cell density at 6 months postoperatively were the main outcome measures. RESULTS: One hundred consecutive eyes were enrolled in the study, and 100% follow-up at 6 months was achieved. Postoperative complications included 2 graft dislocations (2%), and both grafts were attached successfully and cleared; 2 episodes of cystoid macular edema (2%) occurred, and 1 eye (1%) developed areas of anterior iris synechiae to the graft. There were no pupillary block episodes or primary graft failures. In eyes without comorbidity (n=57), the mean BSCVA improved from 20/48 preoperation to 20/29 at 6 months after operation (P<0.001). No eyes lost vision. Mean central endothelial cell density decreased from 2769 cells per square millimeter preoperatively to 2308 cells per square millimeter postoperatively at 6 months. This represented a mean cell loss of 16%. CONCLUSIONS: This study demonstrates that with meticulous attention to a standardized forceps insertion technique, excellent outcomes with low rates of complications, improved BSCVA, and low endothelial cell loss can be achieved with DSAEK surgery.