Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Descemet Stripping Automated Endothelial Keratoplasty With a Retention Suture

Description of a Technique for Patients at High Risk of Graft Detachment

Newman, Lara R. MD*; Rosenwasser, George O. D. MD

doi: 10.1097/ICO.0000000000001672

Purpose: To evaluate the utility, safety, and efficacy of a parallel or cloverleaf retention suture in Descemet stripping automated endothelial keratoplasty that does not penetrate donor tissue and can be removed at the slit lamp for patients at high risk of graft detachment.

Methods: Data were prospectively collected over 9 years from patients who received a retention suture. Indications for use of a retention suture included difficulty with postoperative positioning, abnormal intraocular anatomy including glaucoma tube shunts, trabeculectomies, anterior chamber intraocular lens implants, previous vitrectomy, aniridia, and aphakia, or history of previous graft detachment.

Results: Of 128 surgeries, 12 (9.4%) required additional intervention for graft reattachment (rebubble). Overall, 120 grafts (93.8%) remained clear and attached either after surgery with a retention suture or after rebubble procedures. Mean endothelial cell density at 1 year was 1840 cells/mm2, and mean endothelial cell density loss was 37.3%.

Conclusions: A cloverleaf or parallel retention suture in conjunction with Descemet stripping automated endothelial keratoplasty seems to reduce the risk of detachment in high-risk patients, while maintaining adequate cell density and graft clarity at 1 year.

*Legacy Devers Eye Institute, Portland, OR; and

Central Pennsylvania Eye Institute, Hershey, PA.

Correspondence: Lara R. Newman, MD, Legacy Devers Eye Institute, 1040 NW 22nd Avenue, Suite 200, Portland, OR 97212 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received January 07, 2018

Received in revised form May 06, 2018

Accepted May 12, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.