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