Outcomes of rebubbling for graft detachment after Descemet's stripping endothelial keratoplasty or Descemet's stripping automated endothelial keratoplasty

Incidence and management of early postoperative complications in lamellar corneal transplantation

PURPOSE

To provide a comprehensive review of the incidence, risk factors, and management of early complications after deep anterior lamellar keratoplasty (DALK), Descemet stripping automated keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK).

METHODS

A literature review of complications, that can occur from the time of the transplant up to 1 month after the transplant procedure, was conducted. Case reports and case series were included in the review.

RESULTS

Complications in the earliest postoperative days following anterior and posterior lamellar keratoplasty have shown to affect graft survival. These complications include, but are not limited to, double anterior chamber, sclerokeratitis endothelial graft detachment, acute glaucoma, fluid misdirection syndrome, donor-transmitted and recurrent infection, and Uretts-Zavalia syndrome.

CONCLUSION

It is essential for surgeons and clinicians to not only be aware of these complications but also know how to manage them to minimize their impact on long-term transplant survival and visual outcomes.

Dislocated Descemet Stripping Endothelial Keratoplasty Lenticule in the Anterior Chamber

This case report discusses the dislocation of a Descemet stripping endothelial keratoplasty (DSEK) lenticule in a man aged 82 years who underwent DSEK for pseudophakic bullous keratopathy.

Secondary Endothelial Keratoplasty-A Narrative Review of the Outcomes of Secondary Corneal Endothelial Allografts

BACKGROUND

We review the literature on the efficacy and safety outcomes of secondary Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK).

METHODS

Literature search of English-written publications up to September 27, 2020 in PubMed database, using the terms "endothelial keratoplasty" in combination with keywords "secondary" or "repeat." In addition, we manually searched the references of the primary articles.

RESULTS

Twenty-seven studies (n = 651 eyes) were retained and reviewed, including 10 studies on repeat DSEK, 8 studies on repeat DMEK, 6 studies of DMEK following DSEK, and 3 studies of DSEK after failed DMEK. All studies reported significant improvement in visual acuity after secondary endothelial keratoplasty (EK). Twelve studies compared visual outcomes between primary and secondary EK, reporting conflicting findings. Sixteen studies reported endothelial cell loss rates after secondary EK, and only 1 study reported significantly increased endothelial cell loss rates compared with primary EK. Allograft rejection episodes occurred in 1.8% of eyes (range, 0%-50%). Six studies compared complication rates between primary and secondary EK eyes, and only 1 study found a higher median number of complications. However, 2 studies reported higher regraft failure rates compared with primary EK eyes.

CONCLUSIONS

Secondary EK is surgically feasible and renders significant visual improvement after failed primary EK, although it is not clear whether visual outcomes and allograft survival are comparable with primary EK, raising the question of whether secondary EK eyes are "low risk" as primary EK eyes. Further larger, prospective studies are encouraged to obtain additional quality data on secondary corneal endothelial allotransplantation.

Descemet-stripping automated endothelial keratoplasty with intrascleral haptic-fixated intraocular lens in a sequential vs simultaneous approach

PURPOSE

To compare the outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK) with intrascleral haptic-fixated intraocular lens (IOL) in a sequential and simultaneous approach.

SETTING

Tertiary eyecare center.

DESIGN

Prospective randomized comparative study.

METHODS

Patients with aphakic or complicated pseudophakic bullous keratopathy visiting a tertiary eyecare center were included in the study. A total of 40 patients were randomized into 2 groups of 20 each. Group 1 had subjects who underwent scleral-fixated IOL (SF IOL) implantation by intrascleral haptic fixation technique, followed by DSAEK (sequential procedure) with an interval of at least 3 months. Group 2 (simultaneous) had subjects who underwent DSAEK with SF IOL as a combined procedure. Graft survival, endothelial cell loss (ECL), corrected distance visual acuity (CDVA), and need for any intervention such as rebubbling were evaluated for both the groups at the end of 6 months.

RESULTS

At 6 months, the sequential group had significantly better CDVA of 0.62 ± 0.17 logMAR compared with 0.87 ± 0.19 logMAR in the simultaneous group (P = .002). Group 1 had significantly better overall cumulative graft survival (100% vs 60%, P = .002), significantly lower ECL (P = .006), lesser mean central corneal thickness (P = .03), and significantly thinner donor lenticule (P = .009). Rebubbling rate was significantly higher in Group 2 (P = .025). The mean hyperopic shift was significantly more in Group 2 (P = .02).

CONCLUSION

The sequential procedure of SF IOL followed by DSAEK has better visual outcomes and graft survival when compared with simultaneous procedure in cases of aphakic or complicated pseudophakic bullous keratopathy.

Graft detachments in endothelial keratoplasty

Graft detachment is the most common complication of endothelial keratoplasty. With the ongoing advancements in the field of endothelial keratoplasty, our understanding of risk factors of graft detachments and its management has been evolving. Various prevention measures have been described in literature including presoaking the donor graft, anterior chamber tamponade, venting incisions, sutures to prevent dislocation of graft. Management of a detached graft involves secondary interventions such as rebubbling, suturing and regrafts. In this review, we discuss graft detachment in different types of endothelial keratoplasty techniques including Descemet stripping endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty; with emphasis on incidence, risk factors, preventive measures and their management.