CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2017; 09(01): e26-e31
DOI: 10.1055/s-0037-1609035
Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Outcomes of Resident-Performed Descemet's Stripping Automated Endothelial Keratoplasty

Tatyana R. Beketova
1   Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
,
Margaret L. Pfeiffer
1   Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
2   Robert Cizik Eye Clinic, Houston, Texas
3   Harris Health System, Houston, Texas
,
Alice Z. Chuang
1   Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
,
Gene Kim
1   Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
2   Robert Cizik Eye Clinic, Houston, Texas
3   Harris Health System, Houston, Texas
› Institutsangaben
Weitere Informationen

Publikationsverlauf

21. Juni 2017

07. November 2017

Publikationsdatum:
08. Dezember 2017 (online)

Abstract

Purpose This article aimed to evaluate outcomes of resident-performed Descemet's stripping automated endothelial keratoplasty (DSAEK).

Methods This is a case series of patients who underwent DSAEK performed by PGY-4 ophthalmology residents at Lyndon B. Johnson Hospital from January 2013 to August 2016 staffed by a fellowship-trained cornea specialist. Patients with less than 1 month of follow-up were excluded. Demographics, baseline ocular characteristics, and intraoperative data were recorded. Vision and graft status were recorded at 1 week, 1 month, 3 months, and the last follow-up visits. Surgical failure was defined as graft detachment within 1 week of surgery and/or primary graft failure within 3 months of surgery.

Results Eighteen eyes of 18 patients who followed up for 14.9 months (±12.9) were included. Mean age of patients was 60.9 years (±13.2). Indications for DSAEK included pseudophakic bullous keratopathy (10), Fuchs endothelial dystrophy (4), and other causes of endothelial dysfunction (4). Eleven (61%) eyes had prior ocular surgery, and 7 (39%) had prior glaucoma surgery. There were no postoperative graft detachments and two (11%) primary graft failures. There was one primary graft failure in a glaucoma patient. Of the 16 graft successes, logMAR visual acuity improved by 0.46 logMAR (±0.73) from baseline.

Conclusion With appropriate staffing by an experienced cornea surgeon, DSAEK with residents as the primary surgeons is a safe and effective procedure with reasonably good outcomes.

 
  • References

  • 1 Ang M, Soh Y, Htoon HM, Mehta JS, Tan D. Five-year graft survival comparing Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty. Ophthalmology 2016; 123 (08) 1646-1652
  • 2 Lee WB, Jacobs DS, Musch DC, Kaufman SC, Reinhart WJ, Shtein RM. Descemet's stripping endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology. Ophthalmology 2009; 116 (09) 1818-1830
  • 3 Price MO, Gorovoy M, Benetz BA. , et al. Descemet's stripping automated endothelial keratoplasty outcomes compared with penetrating keratoplasty from the Cornea Donor Study. Ophthalmology 2010; 117 (03) 438-444
  • 4 Price MO, Calhoun P, Kollman C, Price Jr FW, Lass JH. Descemet stripping endothelial keratoplasty: ten-year endothelial cell loss compared with penetrating keratoplasty. Ophthalmology 2016; 123 (07) 1421-1427
  • 5 Hashemi H, Asghari H, Amanzadeh K, Behrooz MJ, Beheshtnejad A, Mohammadpour M. Descemet stripping automated endothelial keratoplasty performed by cornea fellows. Cornea 2012; 31 (09) 974-977
  • 6 Mojica G, Padnick-Silver L, Macsai MS. Incidence of presumed iatrogenic graft failure in Descemet stripping automated endothelial keratoplasty. Cornea 2012; 31 (08) 872-875
  • 7 Price Jr FW, Price MO. Descemet's stripping with endothelial keratoplasty in 200 eyes: early challenges and techniques to enhance donor adherence. J Cataract Refract Surg 2006; 32 (03) 411-418
  • 8 Riaz KM, Grewal DS, Cervantes P, Basti S. Endothelial damage with two DSAEK insertion techniques performed by a novice corneal surgeon in residency training: a comparative analysis. Cornea 2014; 33 (01) 91-95
  • 9 Dapena I, Ham L, Droutsas K, van Dijk K, Moutsouris K, Melles GR. Learning curve in Descemet's membrane endothelial keratoplasty: first series of 135 consecutive cases. Ophthalmology 2011; 118 (11) 2147-2154
  • 10 Shih CY, Ritterband DC, Rubino S. , et al. Visually significant and nonsignificant complications arising from Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 2009; 148 (06) 837-843
  • 11 Decroos FC, Delmonte DW, Chow JH. , et al. Increased rates of Descemet's stripping automated endothelial keratoplasty (DSAEK) graft failure and dislocation in glaucomatous eyes with aqueous shunts. J Ophthalmic Vis Res 2012; 7 (03) 203-213
  • 12 Kang JJ, Ritterband DC, Lai K, Liebmann JM, Seedor JA. Descemet stripping endothelial keratoplasty in eyes with previous glaucoma surgery. Cornea 2016; 35 (12) 1520-1525
  • 13 Bahar I, Kaiserman I, Sansanayudh W, Levinger E, Rootman DS. Busin guide vs forceps for the insertion of the donor lenticule in Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 2009; 147 (02) 220-226
  • 14 Busin M, Bhatt PR, Scorcia V. A modified technique for Descemet membrane stripping automated endothelial keratoplasty to minimize endothelial cell loss. Arch Ophthalmol 2008; 126 (08) 1133-1137
  • 15 Eghrari AO, Riazuddin SA, Gottsch JD. Fuchs corneal dystrophy. Prog Mol Biol Transl Sci 2015; 134: 79-97
  • 16 Shah RD, Randleman JB, Grossniklaus HE. Spontaneous corneal clearing after Descemet's stripping without endothelial replacement. Ophthalmology 2012; 119 (02) 256-260
  • 17 Gorovoy MS. Descemet-stripping automated endothelial keratoplasty. Cornea 2006; 25 (08) 886-889
  • 18 Mehta JS, Por YM, Beuerman RW, Tan DT. Glide insertion technique for donor cornea lenticule during Descemet's stripping automated endothelial keratoplasty. J Cataract Refract Surg 2007; 33 (11) 1846-1850
  • 19 Terry MA, Shamie N, Chen ES, Hoar KL, Friend DJ. Endothelial keratoplasty a simplified technique to minimize graft dislocation, iatrogenic graft failure, and pupillary block. Ophthalmology 2008; 115 (07) 1179-1186
  • 20 Wu EI, Ritterband DC, Yu G, Shields RA, Seedor JA. Graft rejection following Descemet stripping automated endothelial keratoplasty: features, risk factors, and outcomes. Am J Ophthalmol 2012; 153 (05) 949-957.e1
  • 21 Goshe JM, Terry MA, Li JY, Straiko MD, Davis-Boozer D. Graft dislocation and hypotony after Descemet's stripping automated endothelial keratoplasty in patients with previous glaucoma surgery. Ophthalmology 2012; 119 (06) 1130-1133
  • 22 Kim P, Amiran MD, Lichtinger A, Yeung SN, Slomovic AR, Rootman DS. Outcomes of Descemet stripping automated endothelial keratoplasty in patients with previous glaucoma drainage device insertion. Cornea 2012; 31 (02) 172-175
  • 23 Nguyen P, Khashabi S, Chopra V. , et al. Descemet stripping with automated endothelial keratoplasty: a comparative study of outcome in patients with preexisting glaucoma. Saudi J Ophthalmol 2013; 27 (02) 73-78