A Multicenter Study Evaluating the Risk Factors and Outcomes of Repeat Descemet Stripping Endothelial Keratoplasty

Jordan M. Thompson, Alexander H. Truong, Hudson D. Stern, Ali Djalilian, M. Soledad Cortina, Elmer Y. Tu, Paula Johnson, David D. Verdier, Lorene Rafol, David Lubeck, Tatyana Spektor, Colin Jorgensen, Jonathan B. Rubenstein, Parag A. Majmudar, Rushi Talati, Surendra Basti, Robert S Feder, Alan Sugar, Shahzad I. Mian, Neelam Balasubramanian & 3 others Jasmin Sandhu, Bruce I. Gaynes, Charles S. Bouchard

Research output: Contribution to journalArticle

Abstract

PURPOSE: Descemet stripping endothelial keratoplasty (DSEK), currently the most common procedure for managing corneal endothelial dysfunction, may be repeated following DSEK failure from a variety of causes. This multicenter study reports the risk factors and outcomes of repeat DSEK. METHODS: This was an institutional review board-approved multicenter retrospective chart review of patients who underwent repeat DSEK. Twelve surgeons from 5 Midwest academic centers and 3 private practice groups participated. The Eversight Eye Bank provided clinical indication and donor graft data. We also assessed the role of the learning curve by comparing cohorts from the first and second 5-year periods. RESULTS: A total of 121 eyes from 121 patients who underwent repeat DSEK were identified. The average age of the patients was 70 ± 12 years. The most common indication for repeat DSEK was late endothelial graft failure without rejection (58%, N = 63). Average preoperative and 12-month postoperative repeat DSEK corrected distance visual acuities were 20/694 and 20/89, respectively. Visual acuity outcomes, endothelial cell density, and cell loss did not significantly vary between the 2 cohorts. Initial graft rebubble rates for the first and second cohorts were 51% and 25%. The presence of glaucoma, prior glaucoma surgery, or a history of penetrating (full thickness) keratoplasty did not significantly affect visual outcomes. The median, mean, and range of intraocular pressures before repeat DSEK were 15.0, 15.7, and 6 to 37 mm Hg, respectively. Patients with higher intraocular pressures before repeat DSEK had improved postoperative corrected distance visual acuities. CONCLUSIONS: Repeating DSEK improves vision following failed or decompensated DSEK surgery. Higher preoperative repeat DSEK IOPs were associated with improved visual outcomes, and initial graft rebubble rates, which decreased over time, were likely due to surgeon experience.

LanguageEnglish (US)
Pages177-182
Number of pages6
JournalCornea
Volume38
Issue number2
DOIs
StatePublished - Feb 1 2019

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Descemet Stripping Endothelial Keratoplasty
Multicenter Studies
Visual Acuity
Transplants
Intraocular Pressure
Glaucoma
Eye Banks
Learning Curve
Corneal Transplantation
Private Practice
Research Ethics Committees

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Thompson, J. M., Truong, A. H., Stern, H. D., Djalilian, A., Cortina, M. S., Tu, E. Y., ... Bouchard, C. S. (2019). A Multicenter Study Evaluating the Risk Factors and Outcomes of Repeat Descemet Stripping Endothelial Keratoplasty. Cornea, 38(2), 177-182. https://doi.org/10.1097/ICO.0000000000001817
Thompson, Jordan M. ; Truong, Alexander H. ; Stern, Hudson D. ; Djalilian, Ali ; Cortina, M. Soledad ; Tu, Elmer Y. ; Johnson, Paula ; Verdier, David D. ; Rafol, Lorene ; Lubeck, David ; Spektor, Tatyana ; Jorgensen, Colin ; Rubenstein, Jonathan B. ; Majmudar, Parag A. ; Talati, Rushi ; Basti, Surendra ; Feder, Robert S ; Sugar, Alan ; Mian, Shahzad I. ; Balasubramanian, Neelam ; Sandhu, Jasmin ; Gaynes, Bruce I. ; Bouchard, Charles S. / A Multicenter Study Evaluating the Risk Factors and Outcomes of Repeat Descemet Stripping Endothelial Keratoplasty. In: Cornea. 2019 ; Vol. 38, No. 2. pp. 177-182.
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abstract = "PURPOSE: Descemet stripping endothelial keratoplasty (DSEK), currently the most common procedure for managing corneal endothelial dysfunction, may be repeated following DSEK failure from a variety of causes. This multicenter study reports the risk factors and outcomes of repeat DSEK. METHODS: This was an institutional review board-approved multicenter retrospective chart review of patients who underwent repeat DSEK. Twelve surgeons from 5 Midwest academic centers and 3 private practice groups participated. The Eversight Eye Bank provided clinical indication and donor graft data. We also assessed the role of the learning curve by comparing cohorts from the first and second 5-year periods. RESULTS: A total of 121 eyes from 121 patients who underwent repeat DSEK were identified. The average age of the patients was 70 ± 12 years. The most common indication for repeat DSEK was late endothelial graft failure without rejection (58{\%}, N = 63). Average preoperative and 12-month postoperative repeat DSEK corrected distance visual acuities were 20/694 and 20/89, respectively. Visual acuity outcomes, endothelial cell density, and cell loss did not significantly vary between the 2 cohorts. Initial graft rebubble rates for the first and second cohorts were 51{\%} and 25{\%}. The presence of glaucoma, prior glaucoma surgery, or a history of penetrating (full thickness) keratoplasty did not significantly affect visual outcomes. The median, mean, and range of intraocular pressures before repeat DSEK were 15.0, 15.7, and 6 to 37 mm Hg, respectively. Patients with higher intraocular pressures before repeat DSEK had improved postoperative corrected distance visual acuities. CONCLUSIONS: Repeating DSEK improves vision following failed or decompensated DSEK surgery. Higher preoperative repeat DSEK IOPs were associated with improved visual outcomes, and initial graft rebubble rates, which decreased over time, were likely due to surgeon experience.",
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Thompson, JM, Truong, AH, Stern, HD, Djalilian, A, Cortina, MS, Tu, EY, Johnson, P, Verdier, DD, Rafol, L, Lubeck, D, Spektor, T, Jorgensen, C, Rubenstein, JB, Majmudar, PA, Talati, R, Basti, S, Feder, RS, Sugar, A, Mian, SI, Balasubramanian, N, Sandhu, J, Gaynes, BI & Bouchard, CS 2019, 'A Multicenter Study Evaluating the Risk Factors and Outcomes of Repeat Descemet Stripping Endothelial Keratoplasty', Cornea, vol. 38, no. 2, pp. 177-182. https://doi.org/10.1097/ICO.0000000000001817

A Multicenter Study Evaluating the Risk Factors and Outcomes of Repeat Descemet Stripping Endothelial Keratoplasty. / Thompson, Jordan M.; Truong, Alexander H.; Stern, Hudson D.; Djalilian, Ali; Cortina, M. Soledad; Tu, Elmer Y.; Johnson, Paula; Verdier, David D.; Rafol, Lorene; Lubeck, David; Spektor, Tatyana; Jorgensen, Colin; Rubenstein, Jonathan B.; Majmudar, Parag A.; Talati, Rushi; Basti, Surendra; Feder, Robert S; Sugar, Alan; Mian, Shahzad I.; Balasubramanian, Neelam; Sandhu, Jasmin; Gaynes, Bruce I.; Bouchard, Charles S.

In: Cornea, Vol. 38, No. 2, 01.02.2019, p. 177-182.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A Multicenter Study Evaluating the Risk Factors and Outcomes of Repeat Descemet Stripping Endothelial Keratoplasty

AU - Thompson, Jordan M.

AU - Truong, Alexander H.

AU - Stern, Hudson D.

AU - Djalilian, Ali

AU - Cortina, M. Soledad

AU - Tu, Elmer Y.

AU - Johnson, Paula

AU - Verdier, David D.

AU - Rafol, Lorene

AU - Lubeck, David

AU - Spektor, Tatyana

AU - Jorgensen, Colin

AU - Rubenstein, Jonathan B.

AU - Majmudar, Parag A.

AU - Talati, Rushi

AU - Basti, Surendra

AU - Feder, Robert S

AU - Sugar, Alan

AU - Mian, Shahzad I.

AU - Balasubramanian, Neelam

AU - Sandhu, Jasmin

AU - Gaynes, Bruce I.

AU - Bouchard, Charles S.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - PURPOSE: Descemet stripping endothelial keratoplasty (DSEK), currently the most common procedure for managing corneal endothelial dysfunction, may be repeated following DSEK failure from a variety of causes. This multicenter study reports the risk factors and outcomes of repeat DSEK. METHODS: This was an institutional review board-approved multicenter retrospective chart review of patients who underwent repeat DSEK. Twelve surgeons from 5 Midwest academic centers and 3 private practice groups participated. The Eversight Eye Bank provided clinical indication and donor graft data. We also assessed the role of the learning curve by comparing cohorts from the first and second 5-year periods. RESULTS: A total of 121 eyes from 121 patients who underwent repeat DSEK were identified. The average age of the patients was 70 ± 12 years. The most common indication for repeat DSEK was late endothelial graft failure without rejection (58%, N = 63). Average preoperative and 12-month postoperative repeat DSEK corrected distance visual acuities were 20/694 and 20/89, respectively. Visual acuity outcomes, endothelial cell density, and cell loss did not significantly vary between the 2 cohorts. Initial graft rebubble rates for the first and second cohorts were 51% and 25%. The presence of glaucoma, prior glaucoma surgery, or a history of penetrating (full thickness) keratoplasty did not significantly affect visual outcomes. The median, mean, and range of intraocular pressures before repeat DSEK were 15.0, 15.7, and 6 to 37 mm Hg, respectively. Patients with higher intraocular pressures before repeat DSEK had improved postoperative corrected distance visual acuities. CONCLUSIONS: Repeating DSEK improves vision following failed or decompensated DSEK surgery. Higher preoperative repeat DSEK IOPs were associated with improved visual outcomes, and initial graft rebubble rates, which decreased over time, were likely due to surgeon experience.

AB - PURPOSE: Descemet stripping endothelial keratoplasty (DSEK), currently the most common procedure for managing corneal endothelial dysfunction, may be repeated following DSEK failure from a variety of causes. This multicenter study reports the risk factors and outcomes of repeat DSEK. METHODS: This was an institutional review board-approved multicenter retrospective chart review of patients who underwent repeat DSEK. Twelve surgeons from 5 Midwest academic centers and 3 private practice groups participated. The Eversight Eye Bank provided clinical indication and donor graft data. We also assessed the role of the learning curve by comparing cohorts from the first and second 5-year periods. RESULTS: A total of 121 eyes from 121 patients who underwent repeat DSEK were identified. The average age of the patients was 70 ± 12 years. The most common indication for repeat DSEK was late endothelial graft failure without rejection (58%, N = 63). Average preoperative and 12-month postoperative repeat DSEK corrected distance visual acuities were 20/694 and 20/89, respectively. Visual acuity outcomes, endothelial cell density, and cell loss did not significantly vary between the 2 cohorts. Initial graft rebubble rates for the first and second cohorts were 51% and 25%. The presence of glaucoma, prior glaucoma surgery, or a history of penetrating (full thickness) keratoplasty did not significantly affect visual outcomes. The median, mean, and range of intraocular pressures before repeat DSEK were 15.0, 15.7, and 6 to 37 mm Hg, respectively. Patients with higher intraocular pressures before repeat DSEK had improved postoperative corrected distance visual acuities. CONCLUSIONS: Repeating DSEK improves vision following failed or decompensated DSEK surgery. Higher preoperative repeat DSEK IOPs were associated with improved visual outcomes, and initial graft rebubble rates, which decreased over time, were likely due to surgeon experience.

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