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

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 Feder; Alan Sugar; Shahzad I. Mian; Neelam Balasubramanian; Jasmin Sandhu; Bruce I. Gaynes; Charles S. Bouchard

doi:10.1097/ICO.0000000000001817

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

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 Feder, Alan Sugar, Shahzad I. Mian, Neelam BalasubramanianJasmin Sandhu, Bruce I. Gaynes, Charles S. Bouchard

^*Corresponding author for this work

Ophthalmology

Research output: Contribution to journal › Review article › peer-review

6 Scopus citations

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 6 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.

Original language	English (US)
Pages (from-to)	177-182
Number of pages	6
Journal	Cornea
Volume	38
Issue number	2
DOIs	https://doi.org/10.1097/ICO.0000000000001817
State	Published - Feb 1 2019

Keywords

DSEK
endothelial keratoplasty
repeat DSEK

ASJC Scopus subject areas

Ophthalmology

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10.1097/ICO.0000000000001817

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Thompson, J. M., Truong, A. H., Stern, H. D., Djalilian, A., Cortina, M. S., Tu, E. Y., Johnson, P., Verdier, D. D., Rafol, L., Lubeck, D., Spektor, T., Jorgensen, C., Rubenstein, J. B., Majmudar, P. A., Talati, R., Basti, S., Feder, R., Sugar, A., Mian, S. I., ... Bouchard, C. S. (2019). A Multicenter Study Evaluating the Risk Factors and Outcomes of Repeat Descemet Stripping Endothelial. Cornea, 38(2), 177-182. https://doi.org/10.1097/ICO.0000000000001817

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title = "A Multicenter Study Evaluating the Risk Factors and Outcomes of Repeat Descemet Stripping Endothelial",

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 6 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.",

keywords = "DSEK, endothelial keratoplasty, repeat DSEK",

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

year = "2019",

month = feb,

day = "1",

doi = "10.1097/ICO.0000000000001817",

language = "English (US)",

volume = "38",

pages = "177--182",

journal = "Cornea",

issn = "0277-3740",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

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, R, 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', Cornea, vol. 38, no. 2, pp. 177-182. https://doi.org/10.1097/ICO.0000000000001817

TY - JOUR

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

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

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 6 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 6 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.

KW - DSEK

KW - endothelial keratoplasty

KW - repeat DSEK

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U2 - 10.1097/ICO.0000000000001817

DO - 10.1097/ICO.0000000000001817

M3 - Review article

C2 - 30615600

AN - SCOPUS:85059904709

SN - 0277-3740

VL - 38

SP - 177

EP - 182

JO - Cornea

JF - Cornea

IS - 2

ER -

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

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