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Challenging DSAEK cases: lessons from complex cases

Poster Details

First Author: A.Barua UK

Co Author(s):    D. Lake   S. Hamada                 

Abstract Details

Purpose:

Endothelial keratoplasty can be challenging when there are ocular co-morbidities. This case series of complex patients undergoing DSAEK each with particular challenges may help surgeons counsel, plan and manage similar patients.

Setting:

All cases underwent surgery in our tertiary corneal unit and follow-up involved outpatient clinics with use of slit-lamp photography and anterior segment imaging.

Methods:

Cases were identified based on pre-operative factors which would have a potential adverse affect on surgical outcome. DSAEK surgery was carried out with pre-cut donor tissue, and Busin glide was used for insertion. 10 minute full air fill was attempted on each patient, and re-bubbling if necessary. A strict face up posture was maintained while the air was present. The patients were reviewed following surgery, with slit lamp photographs and anterior segment imaging.

Results:

Case 1 had a scleral fixated lens and previous DSAEK which had failed. During the redo DSAEK, the previous graft was removed, and once the new donor tissue was placed, attempted full air fill was unsuccessful because of large iris defects and loss of air around the scleral lens. Another rebubbling of air was required soon after and a strict face up posture was maintained. 360 degree peripheral attachment was observed but no central attachment. Over the next 3 weeks the interface closed and graft fully attached. Case 2 has previous multiple PKs, Ahmed valve, and sulcus IOL with vitreous loss. Air fill was difficult but the graft was partially attached. Despite this the interface cleared and graft fully attached.

Conclusions:

Air fill is important for successful DSAEK surgery, however these cases highlight that a high pressure 10 minute air fill is not essential for full attachment. Options include leaving as much air as possible post operatively with a strict face-up posture to prevent air migration. Even if the graft is not fully attached, if there is signifiant peripheral attachment the central interface should close and attach with time. Repeat air bubbling may cause excessive trauma to the endothelial cells and the air may disperse around the lens in into the vitreous causing pseudo-misdirection collapsing the AC and increasing cell loss.

Financial Disclosure:

NONE

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