Re-attachment of donor button after DSEK can be achieved with postop rebubbling

July 15, 2007

No surgical procedures are without the risk of complications. The most frequently occurring complication after Descemet's stripping endothelial keratoplasty is detachment of the donor button. Attachment is easily achieved with rebubbling in a high percentage of cases. Optical coherence tomography is very useful to observe the interface and elucidate the cause of detachments.

Key Points

Optical coherence tomography (OCT) is useful to observe the interface and elucidate the cause of detachments, she said.

Dr. Suh and colleagues retrospectively reviewed the first 60 cases performed between May 2005 and September 2006 at the Bascom Palmer Eye Institute, Miami, where she is a clinical fellow in the department of Cornea and External Diseases.

"The most frequently occurring complication in this patient series was detachment of the donor button that occurred in 17 of 60 cases," Dr. Suh said. "After the buttons were repositioned and rebubbled, there was a 71% rate of re-attachment."

In three of the 60 cases, DSEK was repeated. In another three cases, penetrating keratoplasty was performed. Two retinal detachments developed; in one case of retinal detachment the patient had a scleral-fixated IOL, and in the other case a scleral-fixated IOL was dislocated and retrieved intraoperatively, after which the retinal detachment was observed to have developed.

Other complications included two cases of cystoid macular edema, three cases of primary graft rejection that was treated with corticosteroid therapy and showed improvement, and three cases of epithelial ingrowth, one of which was observed clinically and two identified on histopathologic examination of the failed grafts. Blood in the interface was seen in two cases, along with one case of haze in the interface, two cases of retained Descemet's membrane, and one case of posterior dislocation of the graft.

Optical coherence tomography (OCT) of the anterior chamber was performed in all cases, and Dr. Suh demonstrated a number of the complications observed on OCT.

"Anterior chamber OCT is also useful for imaging the presence of any interface clefts," Dr. Suh said. "We were able to compare images in which the DSEK is nicely apposed and cases in which a cleft was full of fluid that was later removed."

Performing DSEK is associated with a learning curve for all surgeons, she said.

"We found a high rate of re-attachment after repositioning the donor button and rebubbling," Dr. Suh said. "Anterior chamber OCT images are important in assessing the interface. Histopathologic examination provides clues to the manner in which detachments occur."