Visually Significant and Nonsignificant Complications Arising From Descemet Stripping Automated Endothelial Keratoplasty

Shih, Carolyn Y.; Ritterband, David C.; Rubino, Shaina; Palmiero, Pat-Michael; Jangi, Anisha; Liebmann, Jeffrey; Ritch, Robert; Seedor, John A.

doi:10.1016/j.ajo.2009.06.034

« Previous Next »American Journal of Ophthalmology
Volume 148, Issue 6 , Pages 837-843, December 2009

Visually Significant and Nonsignificant Complications Arising From Descemet Stripping Automated Endothelial Keratoplasty

Carolyn Y. Shih
- Department of Ophthalmology, The New York Eye & Ear Infirmary, New York, New York; and New York Medical College, Valhalla, New York
- Inquiries to Carolyn Y. Shih, 600 Northern Blvd, Suite 214, Great Neck, NY 11021
David C. Ritterband
- Department of Ophthalmology, The New York Eye & Ear Infirmary, New York, New York; and New York Medical College, Valhalla, New York
Shaina Rubino
- Department of Ophthalmology, The New York Eye & Ear Infirmary, New York, New York; and New York Medical College, Valhalla, New York
Pat-Michael Palmiero
- Department of Ophthalmology, The New York Eye & Ear Infirmary, New York, New York; and New York Medical College, Valhalla, New York
Anisha Jangi
- Department of Ophthalmology, The New York Eye & Ear Infirmary, New York, New York; and New York Medical College, Valhalla, New York
Jeffrey Liebmann
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York
- Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital and New York University School of Medicine, New York, New York
Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York
- Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital and New York University School of Medicine, New York, New York
John A. Seedor
- Department of Ophthalmology, The New York Eye & Ear Infirmary, New York, New York; and New York Medical College, Valhalla, New York

Accepted 23 June 2009. published online 05 October 2009.

Purpose

To examine the complications encountered after Descemet stripping automated endothelial keratoplasty (DSAEK) at one institution.

Design

Retrospective case review.

Methods

The first 126 consecutive DSAEKs done at the New York Eye and Ear Infirmary from March 1, 2006 to March 1, 2008 were reviewed. A total of 126 eyes of 113 patients underwent DSAEK. All cases were included regardless of outcome. All complications intraoperatively and postoperatively were recorded.

Results

Graft detachment was the most common complication, occurring in 22 eyes (17.5%); 17 of these (77%) were successfully repositioned. Idiopathic graft failure occurred in 15 eyes (6%). Other visually significant complications included graft rejection (2 eyes), choroidal effusion (2 eyes), epithelial ingrowth (2 eyes), endophthalmitis (1 eye), pupillary block (1 eye), and suture abscess (1 eye). Twenty-four eyes had non–visually significant complications including decentered lenticles, interface fibers, partial peripheral detachments, retained Descemet membrane, and eccentric trephination.

Conclusions

While DSAEK is a viable alternative to penetrating keratoplasty, serious complications may still occur postoperatively. While certain rare complications like endophthalmitis, epithelial ingrowth, and suture abscess may affect vision, more common complications such as decentered lenticles and partial peripheral detachments are less likely to affect visual outcome.