These factors influence success of endothelial keratoplasty
A 9-year follow-up study found that donor tissue characteristics, tissue preparation, and surgical technique influenced outcomes for patients undergoing endothelial keratoplasty.
The retrospective analysis assessed patients undergoing Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) procedures at a single facility between 2013 and 2022.
A total of 1,240 eyes were included: 746 (60.2%) underwent DSAEK and 494 (39.8%) underwent DMEK.
The rebubbling rates were 12.5% with DSAEK and 18.4% with DMEK (P=.005). Rebubbled eyes in the DMEK cohort had comparable refractive outcomes to nonrebubbled eyes (P>.05), while rebubbled eyes in the DSAEK cohort had worse refractive outcomes at all time points (P<.05).
Significant risk factors for DSAEK graft detachment included:
- History of retinal surgery (odds ratio [OR], 2.59)
- Preloaded tissue (OR, 2.70)
- Forceps insertion (OR, 2.33)
- Use of sub50-DSAEK lenticules versus sub100-DSAEK (OR, 2.44) and >100 μm DSAEK (OR, 2.38) lenticules
- Donor history of noninsulin-dependent diabetes (OR, 4.18)
Significant risk factors for DMEK graft detachment included:
- History of cancer in the recipient (OR, 2.51)
- Use of higher SF6 gas concentration (OR, 1.09)
“Identifying and understanding these factors can potentially improve postoperative outcomes,” the authors concluded.
Reference
Mian O, Warmath J, Refai F, et al. Determining risk factors for detachment after endothelial keratoplasties: nine-year review of a single institution. Cornea. 2024. doi:10.1097/ICO.0000000000003658
