Incidence of Presumed Iatrogenic Graft Failure in Descemet Stripping Automated Endothelial Keratoplasty

Purpose: To evaluate presumed iatrogenic graft failure (PIGF) in Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: Deidentified data were collected retrospectively from the Illinois Eye Bank between April 2007 and May 2010. PIGF was defined as cases in which a repeat corneal transplant was performed <8 weeks after an initial DSAEK. Data collected for each case included days between initial DSAEK and regraft, regraft type (DSAEK vs. penetrating keratoplasty), precut versus surgeon-cut tissue, and number of DSAEKs distributed to individual surgeons. Ninety-three cases of PIGF were identified for a group of 46 surgeons who received 2504 corneas. Nine PIGF cases from 4 surgeons in cornea fellowships were analyzed separately. Individual surgeon failure rate and overall failure rate were calculated. Analysis of the overall failure rate was conducted without cases performed by surgeons who train fellows. Effect of surgical experience on PIGF was analyzed. Results: Overall presumed iatrogenic DSAEK failure rate was 3.66% (84 PIGF cases divided by 2294 corneas). Within the group of 4 surgeons that trained fellows, the failure rate was 4.29% (9 cases PIGF divided by 210 corneas). Average time to regraft was 27.5 ± 17.4 days. Initial diagnoses included Fuchs dystrophy, pseudophakic bullous keratopathy, edema, and other disease states. Average donor and recipient ages were 54.3 ± 13.0 and 71.7 ± 11.3 years, respectively. Use of precut versus surgeon-cut tissue did not affect overall failure rates. Failure rates of less experienced surgeons (21.8% ± 10.8%) were higher than more experienced surgeons (1.5% ± 1.4%). Conclusions: Overall, DSAEK failure rates improve as surgeons gain experience. Failure rates in cornea fellowship programs are not excessive.

[1]  M. Terry.  Endothelial keratoplasty: a comparison of complication rates and endothelial survival between precut tissue and surgeon-cut tissue by a single DSAEK surgeon. , 2009, Transactions of the American Ophthalmological Society.

[2]  S. Mccormick,et al.  Failed descemet-stripping automated endothelial keratoplasty grafts: a clinicopathologic analysis. , 2009, American journal of ophthalmology.

[3]  Roni M. Shtein,et al.  Ophthalmic Technology Assessment Descemet ’ s Stripping Endothelial Keratoplasty : Safety and Outcomes , 2022 .

[4]  M. Terry,et al.  Endothelial keratoplasty: vision, endothelial survival, and complications in a comparative case series of fellows vs attending surgeons. , 2009, American journal of ophthalmology.

[5]  I. Dapena,et al.  Endothelial keratoplasty: DSEK/DSAEK or DMEK - the thinner the better? , 2009, Current opinion in ophthalmology.

[6]  M. Terry,et al.  Precut tissue for Descemet's stripping automated endothelial keratoplasty: vision, astigmatism, and endothelial survival. , 2009, Ophthalmology.

[7]  M. Terry,et al.  Endothelial Keratoplasty: The Influence of Preoperative Donor Endothelial Cell Densities on Dislocation, Primary Graft Failure, and 1-Year Cell Counts , 2008, Cornea.

[8]  I. Bahar,et al.  Comparison of posterior lamellar keratoplasty techniques to penetrating keratoplasty. , 2008, Ophthalmology.

[9]  M. Terry.  HIV-1 DNA in peripheral blood mononuclear cells is strongly associated with HIV-1 disease progression in recently infected West African adults. , 2008 .

[10]  F. Price,et al.  Randomized, prospective comparison of precut vs surgeon-dissected grafts for descemet stripping automated endothelial keratoplasty. , 2008, American journal of ophthalmology.

[11]  M. Terry,et al.  Endothelial Keratoplasty: A Simplified Technique to Minimize Graft Dislocation, Iatrogenic Graft Failure, and Pupillary Block , 2008 .

[12]  K. Goins,et al.  Eye bank survey of surgeons using precut donor tissue for descemet stripping automated endothelial keratoplasty. , 2008, Cornea.

[13]  M. Terry,et al.  Descemet-Stripping Automated Endothelial Keratoplasty: Six-month Results in a Prospective Study of 100 Eyes , 2008, Cornea.

[14]  F. Price,et al.  Endothelial cell loss after descemet stripping with endothelial keratoplasty influencing factors and 2-year trend. , 2008, Ophthalmology.

[15]  R. D. Stulting,et al.  The effect of donor age on corneal transplantation outcome results of the cornea donor study. , 2008, Ophthalmology.

[16]  M. Terry,et al.  Endothelial cell loss after Descemet's stripping endothelial keratoplasty in a large prospective series. , 2008, Ophthalmology.

[17]  M. Terry,et al.  Precut tissue in Descemet's stripping automated endothelial keratoplasty donor characteristics and early postoperative complications. , 2008, Ophthalmology (Rochester, Minn.).

[18]  M. Terry.  Precut tissue for descemet stripping automated endothelial keratoplasty: complications are from technique, not tissue. , 2008, Cornea.

[19]  Marianne O Price,et al.  Corneal Transplant Rejection Rate and Severity After Endothelial Keratoplasty , 2007, Cornea.

[20]  William J Dupps,et al.  Visual Acuity, Refractive Error, and Endothelial Cell Density Six Months After Descemet Stripping and Automated Endothelial Keratoplasty (DSAEK) , 2007, Cornea.

[21]  M. Terry,et al.  Histology of Dislocations in Endothelial Keratoplasty (DSEK and DLEK): A Laboratory-Based, Surgical Solution to Dislocation in 100 Consecutive DSEK Cases , 2006, Cornea.

[22]  Marianne O Price,et al.  Descemet's stripping with endothelial keratoplasty in 200 eyes: Early challenges and techniques to enhance donor adherence , 2006, Journal of cataract and refractive surgery.