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Title: Descemet's Stripping Endothelial Keratoplasty Provides Improved Visual Acuity in Patients With Corneal Disease: Presented at ARVO
URL: http://www.pslgroup.com/dg/2206FA.htm
Doctor's Guide
April 30, 2008

By Cameron Johnston

FORT LAUDERDALE, Fla -- April 30, 2008 -- Using Descemet's stripping endothelial keratoplasty (DSEK) to treat intracorneal disease is becoming increasingly popular and offers substantial improvements in best corrected visual acuity for many patients, according to research presented here at the 2008 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO).

In a chart review of 89 patients (97 eyes) included within 1 year of a DSEK operation, rapid rehabilitation in vision was achieved. Patients underwent the procedure for Fuch's disease, endothelial dystrophy, pseudophakic bullous keratopathy, and failed keratopathy grafts.

The mean preoperative best corrected visual acuity was 0.7 logarithm of the minimum angle of resolution (logMAR), which improved to 0.5 logMAR at 1 month postoperative and to 0.3 logMAR at month 3 through month 12 postoperative.

Endothelial cell density, which is a measure of the clarity of the cornea, also improved from 3,007 cells per square millimetre at baseline to 1,973 cells per square millimetre at 1 month postoperative and to 1,575 cells per square millimetre at 12 months postoperative.

The procedure offers a good rate of visual rehabilitation, with excellent visual acuity achieved in many patients.

There were a high number of postoperative complications compared with historical controls, however, that cannot be ignored, noted principal investigator Parisa Taravati, MD, Fellow in Ophthalmology, University of Iowa, Iowa City, Iowa. Pupillary block was seen in 20% of patients, and lenticular dislocation was seen in 25%. These issues were corrected with further procedures.

Overall, graft failure was seen in 3% of patients, and the graft was rejected in 1 patient. These complications, too, required repeat procedures.

The rate of complications indicates the necessity of regular and thorough postoperative examinations to catch problems before they arise or before they turn serious, Dr. Taravati commented.

The DSEK procedure entails opening the edge of the cornea with a small slit, similar to what an ocular surgeon would do when removing a cataract, then "scraping" the inner layer of the cornea to remove the diseased tissue.

The endothelium is then replaced with a new layer consisting of a cadaver cornea that has had the 3 outermost layers "shaved" off. This section of new cornea is inserted inside the recipient's open anterior chamber, where it is held in place against the diseased cornea with compressed air.


[Presentation title: Outcomes Following Descemet's Stripping Endothelial Keratoplasty (DSEK). Abstract D981]

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