Outcomes of endothelial keratoplasty with descemetorhexis (DSEK)

Purpose
Analysis of morphologic and functional outcomes of endothelial keratoplasty with descemetorhexis technique for recipient Descemet’s membrane removal (DSEK).

Material and methods
We analyzed patients treated for chronic endothelial dysfunction with DSEK technique. For the study 12 patients (12 eyes) with follow up at least 9 months, were qualified. Study group consisted of 9 women and 3 men, in age from 53 to 83 years, mean 72.9 ± 7.82 years. All surgery were performed by one surgeon (EW). Anterior chamber was opened through 5 mm wide and 3 mm long sclero–corneal tunnel. Before descemetorhexis incision points on the endothelial side of cornea were done with radio–frequency diathermy. Descemet’s membrane stripping was done with the forceps. Endothelial grafts were fixed with anterior chamber by air tamponade. We analyzed postoperative visual acuity (on Snellen’s charts), corneal transparency, endothelial cell density, total central corneal thickness and endothelial button (with OCT Visante), and complications of the surgery.

Results
9 months postoperatively VA ranged from 0.1 to 0.5 (mean 0.28 ± 0.15), BCVA ranged 0.1 – 0.9 (mean 0.43 ± 0,30). Endothelial cell density ranged from 982 to 2781 cells per square millimeter (mean 1848.5 ± 550.7). Total central corneal thickness ranged from 642 to 998 μm (mean 791.6 ± 38.0 μm) before surgery and from 536 to 789 μm (mean 645 ± 61.3 μm,) 12 months postoperatively . Total central thickness of the endothelial graft 12 months postoperatively ranged from 42 to 163 μm (mean 89.1 ± 38.2 μm). One penetrating keratoplasty was made for graft failure. Due to endothelial graft detachment or dislocation in anterior chamber, air tamponade was made in 5 cases with satisfactory final result. Only one case of the rejection was observed.

Conclusions
Endothelial keratoplasty (DSEK) is safe and effective procedure in treatment of the endothelial cell dysfunction. Surgery supported by descemetorhrexis is easy and quick and results in smooth endothelial graft bed. The DSEK technique decreases surgery time and number of corneal graft dislocations