A complete air removal on same day as descemet’s stripping endothelial keratoplasty (DSEK/DSAEK) leads to prompt restoration of the anterior chamber and thus has been hypothesised to assist with the recovery of endothelial function and promote graft adhesion. The results of this retrospective analysis of single surgeon’s experience over 10 years included 310 patients. All underwent DSEK/DSAEK with complete air bubble removal approximately one hour after their surgery. Overall detachment rate in the whole group was 6.1% – comparable to results in conventional surgery. In the last year of the study graft detachment rate of 1.3% was recorded, which was linked to improved surgeon’s experience and modification of surgical technique. Introduction of mid-peripheral corneal venting incisions, strict removal of all fluid from donor-host interface aided by a use of LASIK flap roller and roughening the peripheral recipient bed to promote donor edge adhesion were introduced to improve graft detachment rate. The rates of late endothelial graft failure (8.1%) and graft rejection (10.7%) were comparable to those reported following conventional surgery. This study shows that low rates of DSEK/DSAEK graft detachment are achievable with complete air removal on the same day, lowering the risk of pupillary block glaucoma and reducing the potential risk of air toxicity to the corneal endothelium.

Graft detachment rate in DSEK/DSAEK after same-day complete air removal graft.
Lehman RE, Copeland LA, Stock EM, Fulcher SF.
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Magdalena Popiela

Royal Gwent Hospital, Cardiff, UK.

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