Analysis of Postoperative Graft Detachment and Donor Tissue Thickness and Quality in DSEK Compared With Combined DSEK-Cataract Surgery

Tuesday, April 29, 2014: 8:31 AM
Room 152 (Boston Convention and Exhibition Center)
Adrian W. Jachens, MD, Ridgewood Ophthalmology, Ridgewood, NJ, USA
Sukru S. Dogan, MD, UT Southwestern Medical Center, Dallas, TX, USA
Sandhya Iyer, MD, UT Southwestern Medical center, Dallas, TX, USA
Venkateswara V. Mootha, MD, UT Soutwestern Medical Center, Dallas, TX, USA
Robert W. Bowman, MD, UT Southwestern Medical Center, Dallas, TX, USA

Narrative Responses:

Purpose
To investigate the rates of post-operative DSEK graft detachment when comparing DSEK done as a solitary procedure versus DSEK done in combination with cataract extraction and IOL implantation.  Also, to analysis pre-operative donor data to determine if a correlation with increase post-operative detachments exists.

Methods
A retrospective chart review of all patients who have undergone DSEK surgery from 2010-13.  In the host patient, we analyzed pathology necessitating surgery, age of patient, prior surgeries, with or without combined cataract extraction, graft adherence at post-op day 1 and week 1, rates of graft failure after initial post-op period.  In the donor tissue, we analyzed the pre-cut graft thickness, age of donor and time of death to preservation.

Results
128 surgeries were identified in patients ages 38-93 years.  There were 55 combined procedures and 73 DSEKs performed.  All DSEK surgeries were performed in pseudophakic or aphakic eyes.  Of the combined cases, 8 (15%) were detached on day 1, 10 (18%) were detached at week 1 compared to solitary cases where 7 (10%) were detached on day 1 and 8 (11%) were detached at week 1.  Of the combined cases, 33% detached overall compared to the solitary cases where 21% detached overall.  Analysis of donor precut tissue thickness, age of donor and time of death to preservation is still pending.

Conclusion
Combined surgery carries a higher risk of graft detachment when compared to solitary DSEK.  Post-operative week 1 detachment is more common than post-operative day 1.  There was no increase incidence of future graft failure in detached grafts when repositioned promptly.  Donor data analysis pending.