DSAEK appears a viable option for buphthalmic eyes

This prospective study found that DSAEK may be performed safely and effectively in buphthalmic eyes, with comparable results to penetrating keratoplasty.

This study is important as it adds to the growing literature reporting that DSAEK can be performed in eyes with anatomical challenges and ocular comorbidities.

This is the first prospective case series of eyes with buphthalmos with endothelial failure undergoing DSAEK. There were 14 transplants performed in 12 eyes (11 patients). Mean age was 34.9 years (range 15 to 54 years). The average follow-up was 21.7 months (range 6 to 48 months). Of note, the authors altered their normal technique and used larger grafts (9.5 to 10.5 mm in diameter) to match the increased corneal size in these eyes.

At the last follow-up examination, BSCVA had improved in 11 of 13 cases, with a logMAR average value ± standard deviation of 0.74 ± 0.66 from the preoperative value of 2.07 ± 0.80. Eleven eyes reached 20/200 or better, and five eyes reached 20/40 or better.

Mean endothelial cell loss was 40.5 percent. Complications included graft detachment (two cases), glaucoma progression (one case) and late endothelial failure (one case). All complications were managed successfully either by repeat DSAEK, rebubbling or cyclocryocoagulation.

The authors write that due to the rarity of the condition, meaningful trials comparing the risks and benefits of penetrating keratoplasty and DSAEK for buphthalmic eye are unlikely to be undertaken. Therefore the best clinical judgment needs to be applied in combination with detailed discussion with the patient and informed consent. Nevertheless, although further studies are needed on long-term graft survival and glaucoma progression, they believe DSAEK to be a viable surgical technique for buphthalmos.