Early Results of Descemet's Stripping and Automated Endothelial Keratoplasty (DSAEK)

1. Keizo Watanabe¹, MD, PhD
2. Masahiko Fukuda¹, MD, PhD
3. Masuo Sakamoto¹, MD
4. Shiro Higaki¹, MD, PhD
5. Akira Kobayashi², MD, PhD
6. Yoshikazu Shimomura¹, MD, PhD

¹Department of Ophthalmology, Kinki University Faculty of Medicine
²Department of Ophthalmology & Visual Science, Kanazawa University Graduate School of Medical Science

Purpose: Descemet's Stripping and Automated Endothelial Keratoplasty (DSAEK) has become increasingly popular in Japan, however, there is inevitable learning curve and high rates of complications. We report our early results of DSAEK.

Methods: Outcomes of our first 17 cases of DSAEK were reviewed retrospectively. The subjects were 17 eyes (5 males and 12 females) which underwent DSAEK performed by 2 surgeons between April 2009 and July 2010. The average age was 72.7 years (range, 28 to 87 years). There were 3 cases of Fuchs' endothelial dystrophy; 2, corneal endothelitis; 2, graft failure after penetrating keratoplasty; 3, pseudophakic bullous keratopathy (PBK); 5, PBK after laser iridotomy; and 2, PBK with previous trabeculectomy. We used the donor pull-through technique with Busin spatula and IOL glide, and 10-minute full air tamponade followed by leaving an air bubble about the size of the donor .

Results: After DSAEK, 12 of 17 eyes (71%) didn't have any complications. Detachment of donor tissues was observed in 3 of 17 eyes. They were all recovered by air re-bubbling. There was one case with minor graft folds leading persistent edematous cornea, which needed repeated DSAEK with a new donor tissue. There was one case with severe rejection leading to graft failure.

Conclusions: In 24%, detachment of donor tissue was observed, but postoperative repositioning with air re-bubbling or repeated DSAEK were useful in most of the cases. It is necessary to reduce the detachment rate by modifying our technique.