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Risk factors for the need of Descemet's stripping automated endothelial keratoplasty graft exchange

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Session Details

Session Title: Cornea: Surgical I

Session Date/Time: Tuesday 08/09/2015 | 08:00-10:30

Paper Time: 09:24

Venue: Room 10

First Author: : B.Filipovic Ricci ITALY

Co Author(s): :    Y. Nahum,   M. Mimouni,   M. Busin              

Abstract Details


To identify risk factors for the failure or unsatisfactory result of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) leading to graft exchange


This is a retrospective cohort study of eyes operated at a private hospital by a single surgeon (MB). Villa Serena-Villa Igea private Hospitals ,Forlì,Italy


The records of all eyes undergoing DSAEK at Villa Serena-Villa Igea private Hospitals (Forlì,Italy) between January 2005 and June 2014 were reviewed.All eyes receiving a repeat DSAEK were assigned to the study group(SG) while all eyes receiving only primary DSAEK during the same period were assigned to the control group (CG).Univariate analysis was performed using Student's t-test or Fisher's exact test as indicated. Multivariate analysis was performed using binary logistic regression in which we introduced as independent those variables that reached a significant level of less than 0.1 in univariate analysis. p values <0.05 were considered significant.


Preoperative BSCVA, lens status and the presence of ocular comorbidities did not differ significantly between the study and the control groups.Fuchs dystrophy was a protective factor against the risk of repeat DSAEK (RR=0.52, 95%CI 0.32-0.82).Indications other than FED or pseudophakic bullous keratopathy portended an increased risk for repeat DSAEK (RR=1.96, 95%CI 1.3-3).Specifically, Buphthalmos was associated with an increased risk for repeat DSAEK (RR=2.82, 95%CI 1.1-6.9).Prior trabeculectomy, aqueous shunt implantation(RR=3.31, 95%CI 1.7-5.9), postoperative graft detachment(RR=3.3, 95%CI 1.7-6.3), a documented rejection episode (RR=7.5, 95%CI 4.9-11.6)were all associated with a significantly higher risk for re-DSAEK.Multivariate analysis showed that lower preoperative BSCVA, prior aqueous shunt implantation,lower donor endothelial cell density, postoperative graft detachment or rejection episode all significantly predicted the need for re-DSAEK.


Our study reaffirmed risk factors for repeat DSAEK previously reported in several smaller studies.

Financial Interest:

One of the authors travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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