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 Venting Incisions in DSAEK Patients: Is It an Absolute Necessity? Authors Johanna Choremis, Silvin Bakalian, Michele Mabon The authors have no financial.

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Presentation on theme: " Venting Incisions in DSAEK Patients: Is It an Absolute Necessity? Authors Johanna Choremis, Silvin Bakalian, Michele Mabon The authors have no financial."— Presentation transcript:

1  Venting Incisions in DSAEK Patients: Is It an Absolute Necessity? Authors Johanna Choremis, Silvin Bakalian, Michele Mabon The authors have no financial interests to disclose

2 Introduction  Venting incisions were first described by Price  They are commonly used in Descemet’s stripping automated endothelial keratoplasty (DSAEK) to remove fluid from the donor-recipient interface to enhance donor graft adherence(1)  Studies show that corneal venting incisions and higher IOP values seemed to facilitate DSAEK donor graft lenticle adhesion to the recipient cornea(2)

3 Purpose The aim of this study is to assess the role of venting incisions during Descemet striping automated endothelial keratoplasty (DSAEK) to assure graft adhesion to the corneal stroma

4 Materials & Methods  A pilot study with a small prospective case series from a tertiary referral surgical center  A total of 40 consecutive eyes that underwent DSAEK surgery were included in the study  One experienced surgeon using the same DSAEK technique (insertion with forceps and incision size of 5,2mm) completed all the surgeries, either without venting incisions (group 1) or with venting incisions (group 2)  Clinical data recorded : age, gender, eye, clinical diagnosis, donor graft endothelial cell density (ECD)

5 Materials & Methods  Intraoperative and postoperative data including complications, venting incisions (with or without), graft detachment, graft dislocation and rebubbling were noted  Patients with only posterior chamber intraocular lens were included in the study  Patients with repeat DSAEK due to graft failure were excluded from the study  The relationship between venting incisions and graft adherence was evaluated for both groups of patients

6 Results  The number of cases were equal for both groups of patients, comprising of 20 cases for each one (group 1=20 cases and group 2=20 cases)  The mean age of patients who underwent DSAEK surgery was 60 years old for group 1 and 59 years old for group 2  The mean donor graft ECD was very similar for both groups of patients (group 1=2729 and group 2=2753)  No intraoperative and postoperative complications were noted for both groups of patients

7 Results  None of the grafts were detached or dislocated in either group of patients  There was no need to do a rebubbling post- operatively for both groups of patients Without venting incision Group 1 With venting incision Group 2 Mean age 6059 Donor graft ECD Rebubbling00

8 Discussion  DSAEK with venting incisions may be an entry site for different microorganisms, leading to corneal and intraocular infections (3-4)  DSAEK with venting incisions can facilitate epithelial ingrowth leading to graft failure (5)  DSAEK with venting incisions can cause irregular corneal astigmatism that may affect post operative visual outcomes (6)

9 Discussion  The goal of venting incisions is to reduce the graft lenticule dislocation rate  Even though our sample size was small we did not notice any difference in dislocation rate for both groups of patients  We believe that venting incisions are not advantageous in preventing graft dislocations

10 Conclusion  Our study suggest that doing DSAEK without venting incisions seems to have no effect on graft detachment and dislocation postoperatively  The limitation of our study is the small sample size  Further studies with larger sample size are needed to validate our results

11 References 1. Price FW Jr, Price MO. Descemet’s stripping with endothelial keratoplasty in 200 eyes: early challenges and techniques to enhance donor adherence. J Cataract Refract Surg. 2006;32(3):411– Vaddavalli PK, Diakonis VF, Canto AP et al: Factors Affecting DSAEK Graft Lenticle Adhesion: An In Vitro Experimental Study. Cornea: June 2014 – Vo Issue 6 - p 551– Hannush SB, Chew HF, Eagle RC JrLate-onset Deep Infectious Keratitis After Descemet Stripping Endothelial Keratoplasty With Vent Incisions. Cornea: February 2011 – Vol 30 - Issue 2 - pp Chew ACY, Mehta JS, Li L et al. Fungal Endophthalmitis After Descemet Stripping Automated Endothelial Keratoplasty-A Case Report. Cornea: March Vol 29 - Issue 3 - pp Suh LH, Shousha MA, Ventura RU, et al. Epithelial Ingrowth After Descemet Stripping Automated Endothelial Keratoplasty: Description of Cases and Assessment With Anterior Segment Optical Coherence Tomography. Cornea: May Vol 30 - Issue 5 - pp Moshirfar M, lependu MT, Church D, et al. In vivo and in vitro analysis of topographic changes secondary to DSAEK venting incisions. Clin Ophthalmol. 2011;5:


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