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Why I prefer PDEK (pre-Descemet's endothelial keratoplasty) advantages over DSEK/DMEK/PK

Poster Details

First Author: L.Daniel Ponniah INDIA

Co Author(s):    A. Agarwal                    

Abstract Details

Purpose:

To evaluate the clinical outcomes of Pre Descemets Endothelial Keratoplasty (PDEK) in varied endothelial dysfunctions and to compare with conventional procedures of Penetrating Keratoplasty (PK) , Descemets Membrane Endothelial Keratoplasty (DMEK) and Descemets Stripping Endothelial Keratoplasty (DSEK) in our practice.

Setting:

Prospective observational case series of clinical outcomes of PDEK and Quality of life (QOL) evaluation over the period of last two years done at Dr.Agarwal's Eye Hospital Tirunelveli ,South India

Methods:

Cases of varied endothelial dysfunctions namely Fuchs dystrophy, bullous keratopathies,failed corneal grafts,ICE and Pseudoexfoliation syndromes,Post hydrops corneas and post trabeculectomy glaucoma with endothelial dysfunctions were enrolled. {n=48} With endothelial side up and 26gauge needle attached to 5ml airfilled syringe,a pneumatic dissection of PreDescemets layer with a single bubble was created,stained with Tryphan blue.A 7.5- 8mm donor tissue (PDEK graft) was excised and implanted through medicel (MIL) injector, after conventional Descemets stripping of recipient cornea. Graft was then unrolled and attached to the recipient cornea with air injection and endo illuminator assistance (which would be video presented)

Results:

48 eyes, mean followup 6 months � 21 days. 39 (81.25%) achieved postoperative vision 20/60 or better.(Mean improvement 1.065 � 0.551 LogMAR, p<0.0001). PDEK graft is possible in donor of any age against above 40 years with DMEK (Pneumatic separation was better). Endothelial preservation in PDEK with pneumatic dissection,(Mean cell loss at 6 months was 22.13%,) was better than DMEK (manual dissection). Corneal thickness of PDEK (565.97 � 44.79mic.) was closer to normal, against DSAEK (618 mic.).PDEK had better pain and recovery scores than PK (7-10 days in PDEK Vs 6-12 months in PK). No suture emergent adverse events

Conclusions:

Pneumatic dissection of PDEK graft was technically easier, better in endothelial preservation and could be done in donors of any age when compared to manual dissection of DMEK and DSAEK,free of suture related issues unlike PK

Financial Disclosure:

NONE

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