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Graft Detachment Rate in DSEK/DSAEK After Same-Day Complete Air Removal

Lehman, Roy E. MD; Copeland, Laurel A. PhD; Stock, Eileen M. PhD; Fulcher, Samuel F. MD

doi: 10.1097/ICO.0000000000000617
Clinical Science

Purpose: We retrospectively analyzed the rate of graft detachment from 310 Descemet stripping endothelial keratoplasty (DSEK)/Descemet stripping automated endothelial keratoplasty (DSAEK) cases performed by a single surgeon over a 10-year period using same-day complete air removal. Secondary outcome measures including primary graft failure, late endothelial graft failure, rejection events, and steroid-induced ocular hypertension were also analyzed.

Methods: A retrospective chart review was performed on all patients receiving DSEK/DSAEK for any cause by the same surgeon at 2 separate institutions from January 2005 to December 2014. The air bubble used to promote graft–host apposition was completely removed after 1 hour. Descriptive statistical analysis was used to report the rates of graft detachment, and χ2 analysis was used to assess for associations with secondary outcomes.

Results: Among 310 endothelial keratoplasties analyzed, there were 19 graft detachments (6.1%). The graft detachment rate was higher during the learning curve, but rapidly declined with experience, and was 1.3% for the last 79 cases over a 4-year period. No primary graft failures were reported. The rate of steroid-induced ocular hypertension was 20%. The rate of graft failure was 8%. The rate of graft rejection events was 10.7%. Two of the 6 patients (33%) who underwent trabeculectomy before endothelial keratoplasty suffered a detachment.

Conclusions: A graft detachment rate as low as 1.3% can be achieved in DSEK/DSAEK with same-day complete air removal shortly after surgery. Factors believed to contribute to a low detachment rate include complete interface fluid removal and reconstitution of the normal anterior chamber milieu to assist corneal endothelial function.

Departments of Ophthalmology, *Baylor Scott and White Hospital, Temple, TX; and

Central Texas Veterans Administration, Temple, TX.

Reprints: Roy E. Lehman, MD, 608 Stanton L. Young Blvd., Oklahoma City, OK 73104 (e-mail:

Supported by Baylor Scott and White Hospital with a travel stipend to present at the World Cornea Congress (April 15–17, 2015).

Partially supported by the Veterans Health Administration. The views are those of the authors and do not necessarily reflect the views of the Department of Veterans Affairs.

The authors have no conflicts of interest to disclose.

Received June 17, 2015

Received in revised form July 11, 2015

Accepted July 28, 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.