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Effects of Postoperative Complications on Endothelial Keratoplasty Outcomes

Effects of Postoperative Complications on Endothelial Keratoplasty Outcomes. William Yang, Abraham Sleem, Robert Eden, Nadia Haqqie, Robert Schultze. Albany Medical College Department of Ophthalmology Division of Cornea, Cataract and Refractive Surgery Albany, NY.

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Effects of Postoperative Complications on Endothelial Keratoplasty Outcomes

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  1. Effects of Postoperative Complications on Endothelial Keratoplasty Outcomes William Yang, Abraham Sleem, Robert Eden, Nadia Haqqie, Robert Schultze Albany Medical College Department of Ophthalmology Division of Cornea, Cataract and Refractive Surgery Albany, NY The authors have no financial interest in the subject matter of this poster.

  2. Purpose • To evaluate the effect of complications on ultimate visual recovery and endothelial cell density after endothelial keratoplasty (EK)

  3. Introduction • The advent of Descemet’s Stripping with Automated Endothelial Keratoplasty (DSAEK) has changed the current approach to the treatment of endothelial diseases. The advantages of this procedure include shorter recovery time, less chance of sight-threatening complications, improved structural integrity of the cornea, and less irregular astigmatism compared to penetrating keratoplasty. Despite these advantages, all procedures come with their own complications such as graft dislocation, graft failure, and pupillary block. This study evaluates the impact of such complications on patient outcomes. Lee et.al. 2009, Terry et.al. 2008

  4. Methods • 36 eyes underwent DSAEK by one surgeon (RLS). At two year post-operatively, best-corrected visual acuity (BSCVA) was obtained using a Snellen visual acuity chart and endothelial cell density was measured using Konan specular microscopy. The initial endothelial cell count was obtained from the eye bank data sheet. Outcomes of patients with early post-operative complications (within one month) were compared retrospectively to those of patients without complications using the Student’s t-test over two years.

  5. Methods • Complications were managed as followed. Graft dislocation was treated by graft repositioning with an air bubble (“rebubbling”). Pupillary block was treated by removing the air bubble. Primary graft failure was treated by replacing the failed EK button.

  6. Results • 19.4% of the eyes had a complication: 4 eyes had graft dislocations, 2 eyes had pupillary block, and 1 eye had primary graft failure. The initial endothelial cell densities of the grafts were 3119±277 cells/mm2 in eyes with complications and 3132±184 cells/mm2 in eyes without complications (p=0.87). The initial pre-operative BSCVA was 20/125 in both patients with and without complications.

  7. Results • The two year post-operative endothelial cell densities in patients with and without complications were 1596±984 cells/mm2 and 1657±621 cells/mm2, respectively (p=0.84). The mean BSCVA in patients with and without complications were 20/40 and 20/50, respectively (p=0.82).

  8. Endothelial Cell Densities

  9. Visual Acuity at 2 Years p value >0.05 BSCVA expressed as logMAR

  10. Conclusions • Recently, varying rates of complications have been reported. Graft dislocation and graft failure have been noted to be as high as 23% and 17% respectively. Despite the presence of a complication such as graft dislocation, primary graft failure, and pupillary block , ultimate patient vision and endothelial cell count do not appear to be affected out to two years postoperatively. Shih et.al. 2009, Suh et.al. 2008

  11. Conclusions • Statistical significance in this study may not have been achieved due to the small sample size however more experience with DSAEK has yielded fewer patients with complications making it more difficult to increase our sample size. In conclusion, despite the more common post-operative complications of DSAEK, patients still ultimately achieve a good outcome from this procedure.

  12. References • Jordan CS et.al. Graft Rejection Episodes After Descemet Stripping with Endothelial Keratoplasty: Part One: Clinical Signs and Symptoms. British Journal of Ophthalmology. 93:387-390. 2009. • Lee WB et.al. Descemet’s Stripping Endothelial Keratoplasty: Safety and Outcomes. Ophthalmology. 116(9):1818-1830. 2009. • Shih CY et.al. Visually Significant and Nonsignificant Complications Arising From Descemet Stripping Automated Endothelial Keratoplasty. American Journal of Ophthalmology. 148(6):837-843. 2009. • Suh LH et.al. Complications of Descemet’s Stripping with Automated Endothelial Keratoplasty. Ophthalmology. 115(9):1517-1524. 2008. • Terry MA et.al. Endothelial Keratoplasty: A Simplified Technique to Minimize Graft Dislocation, Iatrogenic Graft Failure, and Pupillary Block. Ophthalmology. 115(7):1179-1186. 2008.

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