Descemet's Stripping Endothelial Keratoplasty Under Failed Penetrating Keratoplasty: Visual Rehabilitation and Graft Survival Rate
Purpose To evaluate graft survival, risk factors for failure, complications, and visual rehabilitation in patients who underwent Descemet's stripping endothelial keratoplasty (DSEK) under a failed penetrating keratoplasty (PK). Design Retrospective interventional case series. Participants Sixty...
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Veröffentlicht in: | Ophthalmology (Rochester, Minn.) Minn.), 2011-11, Vol.118 (11), p.2155-2160 |
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description | Purpose To evaluate graft survival, risk factors for failure, complications, and visual rehabilitation in patients who underwent Descemet's stripping endothelial keratoplasty (DSEK) under a failed penetrating keratoplasty (PK). Design Retrospective interventional case series. Participants Sixty eyes (60 patients) treated at Price Vision Group, Indianapolis, Indiana. Methods Graft diameters ranged from 8 to 9 mm and were ∼1 mm larger than the previous PK. The Descemet's membrane was not stripped in the majority (54, 84%). The graft was inserted using forceps or a Busin funnel glide (Moria, Anthony, France). The probability of graft survival was calculated by Kaplan–Meier survival analysis. Main Outcome Measures Graft survival, best-corrected visual acuity (BCVA), and complications. Results The mean recipient age was 68 years (range, 17–95 years). Forty eyes had 1 previous failed PK, 14 eyes had 2 previous failed PKs, and 6 eyes had 3 previous failed PKs. Thirty-one eyes (52%) had preexisting glaucoma, and 16 eyes (27%) had prior glaucoma surgery (trabeculectomy in 4, shunt procedure in 12). Fifty-five grafts were performed for visual rehabilitation, and 5 grafts were performed for pain relief. Median follow-up was 2.3 years (range, 2 months to 6 years). Median preoperative BCVA was 1.23 logarithm of the minimum angle of resolution (logMAR) (range, 0.2–3, Snellen 20/340), and median postoperative visual improvement was 0.6 logMAR (6 lines), range −0.3 to +2.7. Four eyes had graft detachment (6.6%), 7 eyes (10.5%) had endothelial rejection, and 10 eyes (16.6%) had graft failure (primary failure in 2, secondary failure in 8). The overall secondary graft survival rates were 98%, 90%, 81%, and 74% at 1, 2, 3, and 4 years, respectively. Prior glaucoma shunt was the principal risk factor for graft failure. The graft survival rates were 100%, 96%, 96%, and 96% in eyes without a prior shunt versus 93%, 74%, 44%, and 22% with a prior shunt at 1, 2, 3, and 4 years, respectively ( P =0.0005; relative risk = 20). Peripheral anterior synechiae ( P =0.14), neovascularization ( P =0.88), endothelial rejection ( P =0.59), and number of prior PKs ( P =0.13) were not independent risk factors for graft failure. Conclusions Endothelial keratoplasty under a previous failed PK is a useful alternative to a repeat standard PK, particularly in eyes with an acceptable topography and refractive outcome before failure. Financial Disclosure(s) Proprietary or commercial disclosure may be |
doi_str_mv | 10.1016/j.ophtha.2011.04.032 |
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Design Retrospective interventional case series. Participants Sixty eyes (60 patients) treated at Price Vision Group, Indianapolis, Indiana. Methods Graft diameters ranged from 8 to 9 mm and were ∼1 mm larger than the previous PK. The Descemet's membrane was not stripped in the majority (54, 84%). The graft was inserted using forceps or a Busin funnel glide (Moria, Anthony, France). The probability of graft survival was calculated by Kaplan–Meier survival analysis. Main Outcome Measures Graft survival, best-corrected visual acuity (BCVA), and complications. Results The mean recipient age was 68 years (range, 17–95 years). Forty eyes had 1 previous failed PK, 14 eyes had 2 previous failed PKs, and 6 eyes had 3 previous failed PKs. Thirty-one eyes (52%) had preexisting glaucoma, and 16 eyes (27%) had prior glaucoma surgery (trabeculectomy in 4, shunt procedure in 12). Fifty-five grafts were performed for visual rehabilitation, and 5 grafts were performed for pain relief. Median follow-up was 2.3 years (range, 2 months to 6 years). Median preoperative BCVA was 1.23 logarithm of the minimum angle of resolution (logMAR) (range, 0.2–3, Snellen 20/340), and median postoperative visual improvement was 0.6 logMAR (6 lines), range −0.3 to +2.7. Four eyes had graft detachment (6.6%), 7 eyes (10.5%) had endothelial rejection, and 10 eyes (16.6%) had graft failure (primary failure in 2, secondary failure in 8). The overall secondary graft survival rates were 98%, 90%, 81%, and 74% at 1, 2, 3, and 4 years, respectively. Prior glaucoma shunt was the principal risk factor for graft failure. The graft survival rates were 100%, 96%, 96%, and 96% in eyes without a prior shunt versus 93%, 74%, 44%, and 22% with a prior shunt at 1, 2, 3, and 4 years, respectively ( P =0.0005; relative risk = 20). Peripheral anterior synechiae ( P =0.14), neovascularization ( P =0.88), endothelial rejection ( P =0.59), and number of prior PKs ( P =0.13) were not independent risk factors for graft failure. Conclusions Endothelial keratoplasty under a previous failed PK is a useful alternative to a repeat standard PK, particularly in eyes with an acceptable topography and refractive outcome before failure. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.</description><identifier>ISSN: 0161-6420</identifier><identifier>EISSN: 1549-4713</identifier><identifier>DOI: 10.1016/j.ophtha.2011.04.032</identifier><identifier>PMID: 21906816</identifier><identifier>CODEN: OPHTDG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Corneal Diseases - surgery ; Corneal Endothelial Cell Loss - diagnosis ; Descemet Stripping Endothelial Keratoplasty ; Female ; Graft Survival - physiology ; Humans ; Intraoperative Complications ; Kaplan-Meier Estimate ; Keratoplasty, Penetrating ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; Ophthalmology ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Risk Factors ; Treatment Failure ; Vision Disorders - rehabilitation ; Visual Acuity - physiology ; Young Adult</subject><ispartof>Ophthalmology (Rochester, Minn.), 2011-11, Vol.118 (11), p.2155-2160</ispartof><rights>American Academy of Ophthalmology</rights><rights>2011 American Academy of Ophthalmology</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c512t-23e1e024ca559d732cbbde291183a927560a3c558721ffd1bd40fe2c2d415c8c3</citedby><cites>FETCH-LOGICAL-c512t-23e1e024ca559d732cbbde291183a927560a3c558721ffd1bd40fe2c2d415c8c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ophtha.2011.04.032$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24729549$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21906816$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Anshu, Arundhati, FRCSED</creatorcontrib><creatorcontrib>Price, Marianne O., PhD</creatorcontrib><creatorcontrib>Price, Francis W., MD</creatorcontrib><title>Descemet's Stripping Endothelial Keratoplasty Under Failed Penetrating Keratoplasty: Visual Rehabilitation and Graft Survival Rate</title><title>Ophthalmology (Rochester, Minn.)</title><addtitle>Ophthalmology</addtitle><description>Purpose To evaluate graft survival, risk factors for failure, complications, and visual rehabilitation in patients who underwent Descemet's stripping endothelial keratoplasty (DSEK) under a failed penetrating keratoplasty (PK). Design Retrospective interventional case series. Participants Sixty eyes (60 patients) treated at Price Vision Group, Indianapolis, Indiana. Methods Graft diameters ranged from 8 to 9 mm and were ∼1 mm larger than the previous PK. The Descemet's membrane was not stripped in the majority (54, 84%). The graft was inserted using forceps or a Busin funnel glide (Moria, Anthony, France). The probability of graft survival was calculated by Kaplan–Meier survival analysis. Main Outcome Measures Graft survival, best-corrected visual acuity (BCVA), and complications. Results The mean recipient age was 68 years (range, 17–95 years). Forty eyes had 1 previous failed PK, 14 eyes had 2 previous failed PKs, and 6 eyes had 3 previous failed PKs. Thirty-one eyes (52%) had preexisting glaucoma, and 16 eyes (27%) had prior glaucoma surgery (trabeculectomy in 4, shunt procedure in 12). Fifty-five grafts were performed for visual rehabilitation, and 5 grafts were performed for pain relief. Median follow-up was 2.3 years (range, 2 months to 6 years). Median preoperative BCVA was 1.23 logarithm of the minimum angle of resolution (logMAR) (range, 0.2–3, Snellen 20/340), and median postoperative visual improvement was 0.6 logMAR (6 lines), range −0.3 to +2.7. Four eyes had graft detachment (6.6%), 7 eyes (10.5%) had endothelial rejection, and 10 eyes (16.6%) had graft failure (primary failure in 2, secondary failure in 8). The overall secondary graft survival rates were 98%, 90%, 81%, and 74% at 1, 2, 3, and 4 years, respectively. Prior glaucoma shunt was the principal risk factor for graft failure. The graft survival rates were 100%, 96%, 96%, and 96% in eyes without a prior shunt versus 93%, 74%, 44%, and 22% with a prior shunt at 1, 2, 3, and 4 years, respectively ( P =0.0005; relative risk = 20). Peripheral anterior synechiae ( P =0.14), neovascularization ( P =0.88), endothelial rejection ( P =0.59), and number of prior PKs ( P =0.13) were not independent risk factors for graft failure. Conclusions Endothelial keratoplasty under a previous failed PK is a useful alternative to a repeat standard PK, particularly in eyes with an acceptable topography and refractive outcome before failure. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Corneal Diseases - surgery</subject><subject>Corneal Endothelial Cell Loss - diagnosis</subject><subject>Descemet Stripping Endothelial Keratoplasty</subject><subject>Female</subject><subject>Graft Survival - physiology</subject><subject>Humans</subject><subject>Intraoperative Complications</subject><subject>Kaplan-Meier Estimate</subject><subject>Keratoplasty, Penetrating</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Ophthalmology</subject><subject>Postoperative Complications</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Treatment Failure</subject><subject>Vision Disorders - rehabilitation</subject><subject>Visual Acuity - physiology</subject><subject>Young Adult</subject><issn>0161-6420</issn><issn>1549-4713</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk1v1DAQhiMEokvhHyDkC-opwWM7XxyQUGkLohKIpVwtx56wXrJOsJ2V9sovx9EuH-LCyQc_74zn8WTZU6AFUKhebItx2sSNKhgFKKgoKGf3shWUos1FDfx-tkoY5JVg9Cx7FMKWUlpVXDzMzhi0tGqgWmU_3mDQuMN4Ecg6ejtN1n0lV86McYODVQN5j17FcRpUiAdy5wx6cq3sgIZ8RIcxXS6Jv6mX5IsNc4p-wo3q7GBjYkZHlDPkxqs-kvXs93a_ECri4-xBr4aAT07neXZ3ffX58m1---Hm3eXr21yXwGLOOAJSJrQqy9bUnOmuM8hagIarltVlRRXXZdnUDPreQGcE7ZFpZgSUutH8PLs41p38-H3GEOXOptmHQTkc5yBbyjhvWdkkUhxJ7ccQPPZy8nan_EEClYt8uZVH-XKRL6mQSX6KPTs1mLsdmt-hX7YT8PwEqKDV0HvltA1_OFGzNn1f4l4dOUw69ha9DNqi02isRx2lGe3_XvJvAT1YZ1PPb3jAsB1n75JqCTIwSeV6WZRlTwAoFdAy_hO-Hbss</recordid><startdate>20111101</startdate><enddate>20111101</enddate><creator>Anshu, Arundhati, FRCSED</creator><creator>Price, Marianne O., PhD</creator><creator>Price, Francis W., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111101</creationdate><title>Descemet's Stripping Endothelial Keratoplasty Under Failed Penetrating Keratoplasty: Visual Rehabilitation and Graft Survival Rate</title><author>Anshu, Arundhati, FRCSED ; Price, Marianne O., PhD ; Price, Francis W., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c512t-23e1e024ca559d732cbbde291183a927560a3c558721ffd1bd40fe2c2d415c8c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Corneal Diseases - surgery</topic><topic>Corneal Endothelial Cell Loss - diagnosis</topic><topic>Descemet Stripping Endothelial Keratoplasty</topic><topic>Female</topic><topic>Graft Survival - physiology</topic><topic>Humans</topic><topic>Intraoperative Complications</topic><topic>Kaplan-Meier Estimate</topic><topic>Keratoplasty, Penetrating</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Ophthalmology</topic><topic>Postoperative Complications</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Treatment Failure</topic><topic>Vision Disorders - rehabilitation</topic><topic>Visual Acuity - physiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Anshu, Arundhati, FRCSED</creatorcontrib><creatorcontrib>Price, Marianne O., PhD</creatorcontrib><creatorcontrib>Price, Francis W., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Ophthalmology (Rochester, Minn.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Anshu, Arundhati, FRCSED</au><au>Price, Marianne O., PhD</au><au>Price, Francis W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Descemet's Stripping Endothelial Keratoplasty Under Failed Penetrating Keratoplasty: Visual Rehabilitation and Graft Survival Rate</atitle><jtitle>Ophthalmology (Rochester, Minn.)</jtitle><addtitle>Ophthalmology</addtitle><date>2011-11-01</date><risdate>2011</risdate><volume>118</volume><issue>11</issue><spage>2155</spage><epage>2160</epage><pages>2155-2160</pages><issn>0161-6420</issn><eissn>1549-4713</eissn><coden>OPHTDG</coden><abstract>Purpose To evaluate graft survival, risk factors for failure, complications, and visual rehabilitation in patients who underwent Descemet's stripping endothelial keratoplasty (DSEK) under a failed penetrating keratoplasty (PK). Design Retrospective interventional case series. Participants Sixty eyes (60 patients) treated at Price Vision Group, Indianapolis, Indiana. Methods Graft diameters ranged from 8 to 9 mm and were ∼1 mm larger than the previous PK. The Descemet's membrane was not stripped in the majority (54, 84%). The graft was inserted using forceps or a Busin funnel glide (Moria, Anthony, France). The probability of graft survival was calculated by Kaplan–Meier survival analysis. Main Outcome Measures Graft survival, best-corrected visual acuity (BCVA), and complications. Results The mean recipient age was 68 years (range, 17–95 years). Forty eyes had 1 previous failed PK, 14 eyes had 2 previous failed PKs, and 6 eyes had 3 previous failed PKs. Thirty-one eyes (52%) had preexisting glaucoma, and 16 eyes (27%) had prior glaucoma surgery (trabeculectomy in 4, shunt procedure in 12). Fifty-five grafts were performed for visual rehabilitation, and 5 grafts were performed for pain relief. Median follow-up was 2.3 years (range, 2 months to 6 years). Median preoperative BCVA was 1.23 logarithm of the minimum angle of resolution (logMAR) (range, 0.2–3, Snellen 20/340), and median postoperative visual improvement was 0.6 logMAR (6 lines), range −0.3 to +2.7. Four eyes had graft detachment (6.6%), 7 eyes (10.5%) had endothelial rejection, and 10 eyes (16.6%) had graft failure (primary failure in 2, secondary failure in 8). The overall secondary graft survival rates were 98%, 90%, 81%, and 74% at 1, 2, 3, and 4 years, respectively. Prior glaucoma shunt was the principal risk factor for graft failure. The graft survival rates were 100%, 96%, 96%, and 96% in eyes without a prior shunt versus 93%, 74%, 44%, and 22% with a prior shunt at 1, 2, 3, and 4 years, respectively ( P =0.0005; relative risk = 20). Peripheral anterior synechiae ( P =0.14), neovascularization ( P =0.88), endothelial rejection ( P =0.59), and number of prior PKs ( P =0.13) were not independent risk factors for graft failure. Conclusions Endothelial keratoplasty under a previous failed PK is a useful alternative to a repeat standard PK, particularly in eyes with an acceptable topography and refractive outcome before failure. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>21906816</pmid><doi>10.1016/j.ophtha.2011.04.032</doi><tpages>6</tpages></addata></record> |
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subjects | Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Corneal Diseases - surgery Corneal Endothelial Cell Loss - diagnosis Descemet Stripping Endothelial Keratoplasty Female Graft Survival - physiology Humans Intraoperative Complications Kaplan-Meier Estimate Keratoplasty, Penetrating Male Medical sciences Middle Aged Miscellaneous Ophthalmology Postoperative Complications Reoperation Retrospective Studies Risk Factors Treatment Failure Vision Disorders - rehabilitation Visual Acuity - physiology Young Adult |
title | Descemet's Stripping Endothelial Keratoplasty Under Failed Penetrating Keratoplasty: Visual Rehabilitation and Graft Survival Rate |
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