Study finds graft detachment most common DSAEK complication

This retrospective study describes the complications 10 surgeons encountered with their first cases of Descemet's stripping with automated endothelial keratoplasty (DSAEK). As in previously published reports of DSAEK outcomes, graft dislocations or detachments were the most common complications, occurring in 27 (23 percent) of 118 eyes in this series.

The procedures were performed by 10 surgeons at a single institution: seven faculty members and three cornea fellows, none of whom had previous DSAEK experience. The authors conclude that DSAEK is an exciting alternative to traditional penetrating keratoplasty, yet the learning curve may be steep and the potential for complications is significant.

In addition to graft detachment, other complications included: graft failure in 21 eyes (17 percent) in which edema was persistent after DSAEK, graft rejection in seven (6 percent), retinal detachment in five (4 percent), cystoid macular edema in six (5 percent), pupillary block after surgery that resolved after removal of the air bubble in two (2 percent) and suprachoridal hemorrhage in one (1 percent).

Of the 27 detachments, 25 were addressed successfully with repositioning, rebubbling or both. One graft reattached spontaneously and one graft in an aphakic eye detached into the vitreous cavity. Successful reattachment of the cornea occurred in 17 of these eyes (68 percent), with 13 of the 17 (76 percent) showing subsequent clearing of the cornea.

Most of the eight remaining detachments were likely due to inexperience performing DSAEK, the authors said, since all four cases performed by the three fellows and earlier cases performed by the faculty surgeons resulted in graft detachment. Grafts were noted to be free floating immediately after the procedure in two eyes; the morphologic features of these grafts showed a thickened edge at one portion of the graft, likely representing eccentric trephination at the time of donor tissue preparation. Retained Descemet's membrane and epithelial ingrowth were also potential causes of dislocation, the authors said.