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Endothelial keratoplasty in failed grafts

Endothelial keratoplasty in failed grafts. Pravin K Vaddavalli Cornea & Refractive surgery Service LV Prasad Eye Institute Hyderabad, India. The authors have no financial interests to disclose. Endothelial keratoplasty evolution. Indications. Fuchs’ endothelial dystrophy

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Endothelial keratoplasty in failed grafts

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  1. Endothelial keratoplasty in failed grafts Pravin K Vaddavalli Cornea & Refractive surgery Service LV Prasad Eye Institute Hyderabad, India The authors have no financial interests to disclose

  2. Endothelial keratoplasty evolution

  3. Indications • Fuchs’ endothelial dystrophy • Pseudophakic and Aphakic corneal edema • Endothelial decompensation • Failed grafts • ICE syndrome • Unsalvageable Descemet’s membrane detachment • TASS • Corneal trauma • Bee sting • Birth trauma • PPMD/ CHED 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 Jul;115(7):1179-86 Bahar I, Kaiserman I, Buys Y, Rootman D Descemet's stripping with endothelial keratoplasty in iridocorneal endothelial syndrome. Ophthalmic Surg Lasers Imaging. 2008 Jan-Feb;39(1):54-6

  4. Indications for endothelial keratoplasty in our first 100 cases Relatively poor outcomes for DSAEK following failed grafts Covert DJ, Koenig SB. Descemet stripping and automated endothelial keratoplasty (DSAEK) in eyes with failed penetrating keratoplasty. Cornea. 2007 Jul;26(6):692-6t

  5. Purpose Evaluate the outcomes of Descemets stripping endothelial keratoplasty (DSEK) in eyes with failed grafts Design Retrospective analysis of all cases of failed grafts undergoing DSEK in a tertiary eye hospital

  6. Methods • Retrospective case analysis • First 100 consecutive cases of DSEK by single surgeon (PKV) • All patients with failed grafts undergoing DSEK Variables • Demographic data • Improvement of best corrected visual acuity • Endothelial cell density • Complications

  7. Results Indications for penetrating keratoplasty • M:F :: 14:8 • Mean age 30.8 ± 19 yrs (7 - 81 yrs) • Indication for PK – Infection, CHED • Lens status

  8. Results • Mean follow up - 6.13 months (1 month – 12 months) • Endothelial cell density: 38.3% endothelial cell loss at 1 month

  9. Results • Best corrected visual acuity (logMAR) improvement from pre op values clinically significant (8 subjects showed improvement in BCVA of 2 lines or more on Snellen charts) p = 0.45

  10. Complications Primary graft failure Allograft rejection Interface scarring Lenticule folds

  11. Results Graft survival: DSEK in failed grafts – 60% Graft survival: DSEK in other indications – 91%

  12. Conclusions • Endothelial keratoplasty in failed grafts good option • Endothelial cell loss mimics that for other indications • Clinically significant visual improvement • Allograft rejection and primary failure more common • Graft survival significantly lower than for other indications

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