Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) Outcomes in High-Risk Patients
Purpose To evaluate the results, survival rates, and proportion of complications related to Descemet Stripping Automated Endothelial Keratoplasty in high-risk patients. Methods Thirty-three patients (thirty-four eyes) who underwent DSAEK surgery between 2015 and 2019 were included in this retrospective, observational study. All participants were considered high-risk patients with a history of previous glaucoma surgery with glaucoma drainage device, previous graft failure, previous anterior
... vious anterior chamber intraocular lens, or glaucoma with an indication of corneal surgery. Results After 7.1 months of follow-up (range from 1 to 35.9 months), seventeen eyes (50%) had graft failure. Among those, eight eyes (47%) belonged to the previous graft failure group, and seven eyes (41%) had a glaucoma drainage device in the anterior chamber. Although best-corrected visual acuity (BCVA) did not improve significantly postoperatively (p = 0.112), twelve eyes improved their visual acuity, and fifteen eyes remained unchanged. The percentage of eyes with BCVA of 20/40 or better improved from 11% preoperatively to 26% postoperatively. The most common surgical complication was lamellae dislocation, occurring in six eyes. Conclusions Adverse outcomes are highly common in high-risk patients who receive a DSAEK, especially in those patients for whom a graft previously failed or with a glaucoma drainage device. The most common complication was graft detachment, with a rate similar to other reports in non-high-risk patients. In our series, previous graft failure is a higher risk factor than a GDD.