Surgical outcomes of endothelial keratoplasty safety-basket suture for management of difficult cases

Objective: To report outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) safety-basket suture technique in complex eyes in which an air bubble could not be maintained in the anterior chamber. Study design: Retrospective chart review. Participants: Patient's undergoing DSAEK with use of the safety-basket suture technique in patients with corneal edema secondary to endothelial dysfunction with up to 3 years of follow-up between 2013 and 2016. Methods: Outcome measures were corrected distance visual acuity, average endothelial cell count loss, graft decentration, graft detachment, rebubble rate, infection rate, graft rejection, and graft failure were analyzed. Results: The technique was used successfully for 36 high-risk cases with no incidence of graft decentration, postoperative infection, or graft rejection. Both the graft detachment and rebubble rate was found to be 11.1%. The graft failure rate was found to be 22.2% with an average of 3.3 months, with 37.5% of these being primary failure and 62.5% of these being secondary failure. Conclusions: Endothelial keratoplasty safety-basket suture is a technique that can be beneficial in difficult DSAEK cases with a lower graft detachment rate compared with the current literature as well as a fairly low complication rate and graft failure while maintaining good visual outcomes. The safety-basket suture is the technique of choice for cases of aphakia and may allow for DSAEK in cases previously that may have only been considered for full-thickness keratoplasty.