Experience and 12-month results of Descemet-stripping endothelial keratoplasty (DSEK) with a small-incision technique

Purpose: To report our clinical experience and 12-month results of small-incision Descemet-stripping endothelial keratoplasty (DSEK). Methods: Prospective study of 11 eyes of 9 patients who had DSEK. The DSEK technique consisted of stripping the Descemet membrane and endothelium from the recipient cornea. The donor button was prepared by manual dissection and inserted through a 5-mm incision. Air, sulfur hexafluoride (SF6) or perfluoropropane (C3F8) was used both at the end of surgery and in subsequent dislocations to promote donor tissue adherence. Results: Mean age was 79.6 years (range, 66-91 years), and minimum follow-up was 12 months (range, 12-18 months). Nine eyes had donor tissue dislocation postoperatively, 8 of which received intervention with either SF6 (n = 4) or C3F8 (n = 4). In 1 patient with repeat dislocation, Tisseel glue in combination with C3F8 was used. Preoperative best-corrected visual acuity (BCVA) was 6/24 or worse in all patients. Postoperatively, 6/11 eyes (55%) achieved a BCVA of 6/12 at last follow-up. Mean preoperative cylinder was 1.875 +/- 0.906 D (range, 1-3 D) and postoperatively was 1.5 +/- 1.157 D (range, 0.25-3.25 D). At last follow-up, 6 grafts were clear and 5 had failed. Mean endothelial cell count in the clear grafts at 12-month follow-up was 1078 +/- 507 cells/mm(2). Conclusions: DSEK provided excellent refractive and reasonable visual outcomes in our limited series, but there were frequent problems with dislocation of the donor tissue, and the graft failure rate was high. The graft failures may be linked to excessive endothelial damage, and the high dislocation rate may be linked to not filling the anterior chamber totally with air after insertion of the donor. Further development of the procedure is necessary.