Objective: To summarize intra and post operation complications and their treatment of Descemet's Stripping Automated Endothelium Keratoplasty (DSAEK), and provide our experience for its development in China.
Methods: Retrospective case study. Forty-seven eyes of 42 patients underwent DSAEK performed by one surgeon. Indications include: Pseudophakic or aphakic Bullous Keratopathy, 27 eyes (57.4%); Fuchs Endothelial Dystrophy, 7 eyes (14.9%); endothelial decompensation post vitrectomy, 3 eyes (6.4%); iridocorneal endothelial syndrome (ICE), 3 eyes (6.4%); congenital glaucoma, 3 eyes (6.4%); graft failure post endothelial keratoplasty, 3 eyes (6.4%); endothelial decompensation after open ocular injury and intraocular foreign body, 1 eye (2.1%). Nineteen eyes underwent single DSAEK (40.4%); eight combined phacoemulsification and intraocular lens implantation (17.0%); eight combined anterior chamber IOL (AC-IOL) removal plus anterior segment vitrectomy and posterior chamber IOL (PC-IOL) implantation (17.0%); eight combined anterior segment vitrectomy and PC-IOL suspension (17.0%); two combined cataract extraction and anterior segment vitrectomy (4.3%); two failed in DSAEK and underwent penetrating keratoplasty (4.3%).
Results: Dislocation is the most common postoperative complications. Ten eyes underwent dislocation in 47 eyes (21.3%), which was solved by air and viscoelastic agent injection. High intraocular pressure happened in 12 eyes (25.5%), in 11 of which had a history of glaucoma and 1 with ICE. After drug treatment, ten patients had stable intraocular pressure and two patients underwent ciliary body photocoagulation surgery (1 case with anterior chamber intraocular lens, 1 case with ICE). Reactions happened in 2 cases (4.3%) patients, including 1 case with anterior chamber IOL (AC-IOL) rehabilitating after drug treatment and the other with Fuch's corneal endothelial dysfunction being regrafted.
Conclusion: Dislocation is the most common complication after corneal endothelial keratoplasty, and air injection in anterior chamber is a common and effective method; High intraocular pressure is the second postoperative complication. Preoperative history of glaucoma is closely related to postoperative high intraocular pressure.