Complications after Descemet's stripping endothelial keratoplasty

Purpose: To describe the complication rate and type of intraoperative and postoperative complications of Descemet stripping endothelial keratoplasty (DSEK). Methods: Retrospective medical records review of patients who underwent DSEK between 2008 and 2010 at the Sorocaba Ophthalmological Hospital. The study was descriptive, using a quantitative approach. Results: One hundred nineteen eyes of 118 patients were evaluated. According to the diagnoses, most patients were diagnosed with Fuchs' dystrophy (60 eyes, 50.4%), followed by patients with pseudophakic bullous keratopathy in 55 eyes (46.2%). The most common procedure performed was DSEK alone, performed in 65 eyes (54.6%), followed by the DSEK associated to phacoemulsification (PHACO-DSEK) in 47 eyes (39.5%) and DSEK associated to other surgeries (7 eyes, 5.9%). Eight patients were excluded from the study due to insufficient information in the surgical record. In relation to the intra-operative complications, isolated cases of pupillary block, irregular manual dissection of button, inverted implantation of the button, button-holing and posterior capsule rupture were noticed. Among the documented early postoperative complications, button detachment was observed in 21.5% of the DSEK alone group; 34.0% in PHACO-DSEK group and 57.1% when DSEK was held jointly with other surgical techniques. Regarding to late complications, interface haze was observed in 16.9%, 8.5% and 14.2%, and glaucoma was observed in 4.6%, 2.1% and 14.2% in DSEK, PHACO-DSEK and DSEK associated to other techniques, respectively. Post rejection graft failure was observed in 15.3% and 12.7% of the eyes after DSEK and. PHACO-DSEK, respectively. Conclusion: Endothelial corneal transplant accomplished in this sample showed a high rate of complications when compared to the conventional penetrating keratoplasty. The most frequent complications were related to detachment of the button and graft failure.