Surgeons need to be aware of potential DSAEK complications

Descemet's stripping automated endothelial keratoplasty offers an effective alternative to traditional penetrating keratoplasty, but the procedure carries a significant risk for a number of complications, according to a retrospective study. Novice surgeons should familiarize themselves with the severity and scope of these complications in order to develop effective preventative techniques, the authors said.

Leejee H. Suh, MD, and colleagues reviewed intraoperative and postoperative complications for 118 eyes of 99 patients who underwent DSAEK. All detached DSAEK grafts were repositioned and/or rebubbled immediately after being diagnosed.

The investigators identified graft detachments in 27 eyes (23%); all but one of these detached grafts were successfully repositioned or rebubbled.

The cornea was successfully reattached in 17 eyes (68%), the authors noted.

DSAEK failures, defined by the persistence of edema after the procedure, were identified in 21 eyes (17%). In addition, seven eyes (6%) had rejected grafts, five eyes (4%) developed retinal detachments, six eyes (5%) developed cystoid macular edema, one eye (1%) developed epithelial ingrowth, one eye had blood in the graft interface, one eye developed a suprachoroidal hemorrhage during surgery, and two eyes (2%) developed postoperative pupillary blocks that were resolved through removal of the air bubble.

"In one aphakic patient, an air bubble could not be maintained during surgery, and sulfur hexafluoride was injected into the anterior chamber," the study authors said in the September issue of Ophthalmology.