Outcomes of DSEK in Vitrectomized Eyes
Purpose
To investigate the incidence of intra- and postoperative complications and clinical outcomes of vitrectomized eyes undergoing DSEK via a standard technique.
Methods
This was a retrospective case series of vitrectomized eyes undergoing DSEK performed by one surgeon between 2008-2014. 17 eyes from 16 patients were analyzed. All eyes underwent mechanical anterior vitrectomy at the time of DSEK. The standard technique was as follows: Descemet's stripping first, followed by intraocular lens exchange using a sutured sulcus-fixated IOL if needed, anterior vitrectomy, then donor insertion via forceps with subsequent 100% air fill to achieve graft adherence.
Results
Follow-up ranged from 4 to 25 months. 5 eyes were rebubbled on the first postoperative day, with adherence achieved after one attempt in 4 eyes. The other eye had primary graft failure; repeat DSEK 4 months later was successful. Preoperatively, 9 eyes had BCVA between 20/50 and 20/200 and 8 had BCVA ≤ 20/400. At the last postoperative visit, all grafts were clear but only 5 eyes had BVCA ≥ 20/40. In the remaining 12 eyes, the decreased vision was secondary to preexisting glaucoma or retinal pathology.
Conclusion
DSEK can be successful in vitrectomized eyes, with a reasonably low rebubbling rate of 29% due to our standard surgical technique. Despite successful surgery and 100% graft clarity, visual prognosis remains guarded because of prior pathology in these patients.