Suture Pull-Through Insertion Techniques for Descemet Stripping Automated Endothelial Keratoplasty in Chinese Phakic Eyes: Outcomes and Complications

PURPOSE To investigate the outcomes and complications of suture pull-through insertion techniques for Descemet stripping automated endothelial keratoplasty (DSAEK) in Chinese phakic eyes. PATIENTS AND METHODS Retrospective case series. Included in the study were all Chinese patients with phakic eyes who underwent DSAEK at Peking University Third Hospital from August 2008 to August 2011. All ocular diseases of the patients were recorded. Distance visual acuity (DVA), near visual acuity (NVA), intraocular pressure (IOP), anterior chamber depth (ACD), central corneal thickness (CCT), and corneal endothelial cell density (ECD) were compared prior to and 12 months after DSAEK. The DSAEK success rate, endothelial cell loss (ECL), complications, and prognosis were analyzed. All patients had at least 12 months of follow up. RESULTS Twenty-one eyes of 16 patients were included (11 males and 5 females). Ages ranged from 2 to 47 years with an average age of 29.8 years. The average follow up was 15.4 months (ranging from 12 to 36 months). Diagnoses included 7 eyes (4 patients) with corneal endothelial dystrophy and 14 eyes (12 patients) with bullous keratopathy. Presurgical DVA and NVA (LogMAR) were 1.7 ± 0.7 and 1.2 ± 0.4; postsurgical DVA and NVA were 0.8 ± 0.6 and 0.7 ± 0.5; Z = -3.517, -2.764; P<0.001 and P = 0.006 respectively. Presurgical IOP was 15.8 ± 3.7 mm Hg; postsurgical IOP was 15.2 ± 2.6 mm Hg; Z = -0.505, P = 0.614. Presurgical ACD was 3.00 ± 0.74 mm; postsurgical ACD was 2.72 ± 0.59 mm; Z = -0.524, P = 0.600. Donor ECD was 2992 ± 163 cells/mm(2), ECD was 1836 ± 412 cells/mm(2) with a 12-month postsurgical ECL of 39%. Success rate was 86%. Surgery complications included pupillary block-induced hypertension in 5 eyes (24%), graft detachment in 3 eyes (14%), and graft dislocation in 1 eye (5%). CONCLUSIONS DSAEK on Chinese phakic eyes can significantly improve DVA and NVA by preserving the patient's own crystalline lens. DSAEK is an optional surgery for patients who need to preserve accommodative function. More attention should be given to postsurgical pupillary block-induced hypertension.