Endothelial keratoplasty a simplified technique to minimize graft dislocation, iatrogenic graft failure, and pupillary block

Ophthalmology. 2008 Jul;115(7):1179-86. doi: 10.1016/j.ophtha.2007.09.005. Epub 2007 Dec 3.


Purpose: Endothelial keratoplasty is an exciting alternative to full-thickness penetrating keratoplasty for replacing the diseased endothelium, yet 3 of the major complications seen are dislocation of the donor tissue, primary graft failure (PGF), and pupillary block from the residual, supportive air bubble. Surgical strategies were developed to reduce the likelihood of occurrence of these complications in our first 200 consecutive Descemet's stripping automated endothelial keratoplasty (DSAEK) cases.

Design: Prospective, noncomparative, interventional case series.

Participants: Two hundred eyes of 172 patients with corneal edema.

Methods: An institutional review board-approved, prospective protocol of endothelial keratoplasty was initiated. Four different surgeons performed DSAEK for the initial 200 consecutive cases using a technique of peripheral recipient bed scraping for donor edge adherence and leaving a residual supportive air bubble, which was freely mobile, and <or=9 mm in diameter. The incidence of early postoperative complications was then determined.

Main outcome measures: Postoperative donor graft dislocation, iatrogenic PGF, and pupillary block glaucoma.

Results: There were only 3 dislocations into the anterior chamber in this series of 200 consecutive eyes (1.5% dislocation rate) and all were successfully reattached with a second air bubble. There were no dislocations in the last 115 consecutive cases. There were two cases of donors that were attached but decentered in this series. There were no PGFs. There was not a single case of pupillary block in the entire series.

Conclusion: The surgical technique described in this series, which utilized peripheral recipient bed scraping, has an acceptably low dislocation rate (1.5%) and yielded no cases of iatrogenic PGF. The complication of pupillary block was never seen in this series, likely due to our technique of utilizing a freely mobile, <or=9 mm residual air bubble at the conclusion of surgery.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anterior Chamber / surgery
  • Blister / surgery
  • Corneal Transplantation / methods*
  • Descemet Membrane / surgery*
  • Endothelium, Corneal / transplantation*
  • Female
  • Fuchs' Endothelial Dystrophy / surgery
  • Graft Rejection / prevention & control*
  • Graft Survival
  • Humans
  • Iatrogenic Disease / prevention & control*
  • Male
  • Middle Aged
  • Phacoemulsification
  • Postoperative Complications
  • Prospective Studies
  • Pupil Disorders / prevention & control*
  • Tissue Donors