OJOph  Vol.4 No.3 , August 2014
A Novel Y-Suture Transfixation Technique to Improve Graft Adherence in High-Risk Descemets Stripping Automated Endothelial Keratoplasty
ABSTRACT

Purpose: To report a novel Y-suture transfixation technique to improve success rate of high-risk Descemets stripping automated endothelial keratoplasties (DSAEK). Design: Retrospective non-comparative case series. Participants: Twenty five high-risk patients undergoing DSAEK at one tertiary care institution. Methods: A retrospective evaluation of consecutively enrolled high-risk DSAEK cases performed by three surgeons at one institution during a 3-year period (2007-2010). Main outcome measures were graft adherence and suture-related complications. Results: Highrisk factors were defined as followed: prior incisional glaucoma surgery (58%), presence of vitreous in the anterior chamber (15%), anterior chamber intraocular lens (8%), graft dislocation (8%), previous DSAEK (8%), and iris trauma/aphakia (3%). Twenty-five high-risk patients underwent DSAEK with Y-suture transfixation. Postoperative follow-up ranged from 3 to 27 months. One patient had dislocation due to hypotony from prior trabeculectomy (4%), requiring repeat DSAEK. Neither primary graft failure nor suture-related complication was observed. Conclusion: The Y-suture transfixation technique is associated with improved success rate of high-risk DSAEK transplant.


Cite this paper
Cason, J. , Ahmad, H. , Nguyen, P. , Heur, M. , Song, J. and Yiu, S. (2014) A Novel Y-Suture Transfixation Technique to Improve Graft Adherence in High-Risk Descemets Stripping Automated Endothelial Keratoplasty. Open Journal of Ophthalmology, 4, 100-105. doi: 10.4236/ojoph.2014.43016.
References
[1]   Eye Banking Statistical Report. Washington DC. Eye Bank Association of America; 2008.

[2]   Price Jr., FW. and Price, M.O. (2006) Descemet’s Stripping with Endothelial Keratoplasty in 200 Eyes: Early Challenges and Techniques to Enhance Donor Adherence. Journal of Cataract Refractive Surgery, 32, 411-418.
http://dx.doi.org/10.1016/j.jcrs.2005.12.078

[3]   Terry, M., Shamie, N., Chen, E., et al. (2008) Endothelial Keratoplasty—A Simplified Technique to Minimize Graft Dislocation, Iatrogenic Graft Failure, and Pupillary Block. Ophthalmology, 115, 1179-1186.
http://dx.doi.org/10.1016/j.ophtha.2007.09.005

[4]   Bahar, I., Kaiserman, I., McAllum, P., et al. (2008) Comparison of Posterior Lamellar Keratoplasty Techniques to Penetrating Keratoplasty. Ophthalmology, 115, 1525-1533.
http://dx.doi.org/10.1016/j.ophtha.2008.02.010

[5]   Lee, W.B., Jacobs, D.S., Musch, D.C., et al. (2009) Descemet’s Stripping Endothelial Keratoplasty: Safety and Outcomes: A Report by the American Academy of Ophthalmology. Ophthalmology, 116, 1818-1830.
http://dx.doi.org/10.1016/j.ophtha.2009.06.021

[6]   Price, M.O., Gorovoy, M., Benetz, B.A., et al. (2010) Descemet’s Stripping Automated Endothelial Keratoplasty Outcomes Compared with Penetrating Keratoplasty from the Cornea Donor Study. Ophthalmology, 117, 438-444.

[7]   Price, M.O. and Price, F.W. (2007) Descemet’s Stripping Endothelial Keratoplasty. Current Opinion in Ophthalmology, 18, 290-294.
http://dx.doi.org/10.1097/ICU.0b013e3281a4775b

[8]   Melles, G.R., Eggink, F.A., Lander, F., et al. (1998) A Surgical Technique for Posterior Lamellar Keratoplasty. Cornea, 17, 618-626.
http://dx.doi.org/10.1097/00003226-199811000-00010

[9]   Melles, G.R., Lander, F. and Nieuwendaal, C.P. (2002) Sutureless, Posterior Lamellar Keratoplasty: A Case Report of a Modified Technique. Cornea, 21, 325-327.
http://dx.doi.org/10.1097/00003226-199811000-00010

[10]   Terry, M.A. (2003) A New Approach for Endothelial Transplantation: Deep Lamellar Endothelial Keratoplasty. International Ophthalmology Clinics, 43, 183-193.
http://dx.doi.org/10.1097/00004397-200343030-00017

[11]   Nguyen, P., Khashabi, S., Chopra, V., Francis, B., Heur, M., Song, J.C. and Yiu, S.C. (2013) Descemet Stripping with Automated Endothelial Keratoplasty: A Comparative Study of Outcome in Patients with Preexisting Glaucoma. Saudi Journal of Ophthalmology, 27, 73-78.
http://dx.doi.org/10.1016/j.sjopt.2013.02.002

[12]   Singh, A., Gupta, A. and Stewart, J.M. (2010) Posterior Dislocation of Descemets Stripping Automated Endothelial Keratoplasty Graft Can Lead to Retinal Detachment. Cornea, 29, 1284-1286.
http://dx.doi.org/10.1097/ICO.0b013e3181e84402

[13]   Gorovoy, M.S. (2006) Descemets-Stripping Automated Endothelial Keratoplasty. Cornea, 25, 886-889.
http://dx.doi.org/10.1097/01.ico.0000214224.90743.01

[14]   Lee, J.K., Eghrari, A.O., Desai, N.R., Stark, W.J. and Gottsch, J.D. (2009) Presoaking Donor Corneas Reduces Graft Detachment Rates in Descemets Stripping Endothelial Keratoplasty. American Journal of Ophthalmology, 147, 439-441.
http://dx.doi.org/10.1016/j.ajo.2008.09.026

[15]   Meisler, D.M., Dupps Jr., W.J., Covert, D.J. and Koenig, S.B. (2007) Use of an Air-Fluid Exchange System to Promote Graft Adhesion during Descemet’s Stripping Automated Endothelial Keratoplasty. Journal of Cataract & Refractive Surgery, 33, 770-772.
http://dx.doi.org/10.1016/j.jcrs.2006.11.033

[16]   Peng, R., Hao, Y.S., Chen, H.J., Sun, Y. and Hong, J. (2009) Endothelial Keratoplasty: The Use of Viscoelastic as an Aid in Reattaching the Dislocated Graft in Abnormally Structured Eyes. Ophthalmology, 116, 1897-1900.
http://dx.doi.org/10.1016/j.ophtha.2009.03.049

[17]   Patel, A.K., Luccarelli, S., Ponzin, D. and Busin, M. (2011) Transcorneal Suture Fixation of Posterior Lamellar Grafts in Eyes with Minimum or Absent Iris-Lens Diaphragm. American Journal of Ophthalmology, 151, 460-464.
http://dx.doi.org/10.1016/j.ajo.2010.08.043

 
 
Top