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First Author: A.Vicente PORTUGAL
Co Author(s): R. Anjos B. Borges L. Vieira J. Feijão P. Candelária
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To present a retrospective study of 51 eyes of 47 patients submitted to Descemet Stripping Automated Endothelial Keratoplasty.
Endotelial keratoplasty is the preferred surgical approach when treating endothelial disease. There are various indications for DSAEK. The most common indication for DSAEK is pseudophakic bullous keratopathy and Fuchs endothelial dystrophy. It has also been proved to be useful in different genetic diseases (congenital hereditary endothelial dystrophy and irido-corneal-endothelial dystrophy) and oedema from endothelial dysfunctions. The surgical technique includes stripping Descemets membrane and endothelium from the recipient and attaching the donor tissue using air tamponade.
A retrospective study of 51 eyes of 47 patients submitted to DSAEK and operated by the same surgical team from 2009 to 2012 was performed. Indications, visual acuity progress and complications were analyzed. The safety and efficacy of the procedure was also studied.
Patients had a mean age of 71 years when operated and 64,7% were women. Pseudophakic bullous keratopathy was the indication in 58,8% of the cases, Fuchs endothelial dystrophy in 39,2% and bullous keratopathy after AC IOL implantation in 2%. In 13,7% of the cases the DSAEK procedure was performed together with phacoemulsification and IOL implantation. There were no intraoperative complications. Preoperative average visual acuity was 0,19 and best postoperative average visual acuity was 0,44. The postoperative complication rate was 21,6% and included dislocations, graft failures, pupillary block angle closure, vitritis and macular oedema.
There was a significant average visual acuity increase, comparable to the increase verified by other published studies. Postoperative complication rate was also within the expected results. The results demonstrated a fast visual recovery and less postoperative inflammation. DSAEK is now a safe and approved alternative to penetrating keratoplasty and it must be considered in the treatment of the patients that have endothelial dysfunction without stromal pathology.