Outcomes of complex Descemet Stripping Endothelial Keratoplasty performed by cornea fellows

Jacquelyn Daubert, Terrence O'Brien, Eldad Adler, Oriel Spierer

Research output: Contribution to journalArticle

Abstract

Background: A major obstacle that academic institutions face is the steep learning curve for cornea fellows initially learning to perform Descemet Stripping Endothelial Keratoplasty (DSEK). The purpose of this study is to evaluate the outcomes of complex DSEK performed by cornea fellow supervised by an attending surgeon at an academic institution. Methods: Patients who underwent a complex DSEK procedure performed by a cornea fellow during the years 2009-2013 were included. All the surgeries were supervised by the same cornea attending. All patients had a minimum follow-up of 6 months. Charts were reviewed for demographic data, intraoperative and postoperative complications and clinical outcomes. Corneal graft survival was calculated using the Kaplan-Meier analysis. Results: Fifty-seven eyes of 55 patients (mean age 77.5 ± 8.5 years) were included in the study with a mean follow-up time of 16.4 ± 15.6 months. Previous graft failure, presence of a tube and history of trabeculectomy were the leading diagnoses to define the surgery as complex. No intraoperative complications occurred. In 21.1% of cases a corneal graft detachment was documented in the first postoperative day. Mean visual acuity improved from 1.06 LogMAR (20/230) preoperatively to 0.39 LogMAR (20/50, p < 0.001) by the sixth postoperative month and to 0.52 LogMAR (20/65, p < 0.001) at the last follow-up visit. Graft failure rate was 29.8%. Kaplan-Meier analysis found a 67.2% graft survival rate at 20 months. Conclusions: Complex DSEK can be performed successfully with an acceptable postoperative complication rate by cornea fellows during their training period when supervised by an experienced attending.

Original languageEnglish (US)
Article number281
JournalBMC Ophthalmology
Volume18
Issue number1
DOIs
StatePublished - Oct 30 2018

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Descemet Stripping Endothelial Keratoplasty
Cornea
Intraoperative Complications
Kaplan-Meier Estimate
Graft Survival
Transplants
Trabeculectomy
Learning Curve
Visual Acuity
Survival Rate
Demography
Learning

Keywords

  • Cornea fellows
  • Descemet Stripping Endothelial Keratoplasty
  • DSEK
  • Ophthalmology fellowship training

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Outcomes of complex Descemet Stripping Endothelial Keratoplasty performed by cornea fellows. / Daubert, Jacquelyn; O'Brien, Terrence; Adler, Eldad; Spierer, Oriel.

In: BMC Ophthalmology, Vol. 18, No. 1, 281, 30.10.2018.

Research output: Contribution to journalArticle

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abstract = "Background: A major obstacle that academic institutions face is the steep learning curve for cornea fellows initially learning to perform Descemet Stripping Endothelial Keratoplasty (DSEK). The purpose of this study is to evaluate the outcomes of complex DSEK performed by cornea fellow supervised by an attending surgeon at an academic institution. Methods: Patients who underwent a complex DSEK procedure performed by a cornea fellow during the years 2009-2013 were included. All the surgeries were supervised by the same cornea attending. All patients had a minimum follow-up of 6 months. Charts were reviewed for demographic data, intraoperative and postoperative complications and clinical outcomes. Corneal graft survival was calculated using the Kaplan-Meier analysis. Results: Fifty-seven eyes of 55 patients (mean age 77.5 ± 8.5 years) were included in the study with a mean follow-up time of 16.4 ± 15.6 months. Previous graft failure, presence of a tube and history of trabeculectomy were the leading diagnoses to define the surgery as complex. No intraoperative complications occurred. In 21.1{\%} of cases a corneal graft detachment was documented in the first postoperative day. Mean visual acuity improved from 1.06 LogMAR (20/230) preoperatively to 0.39 LogMAR (20/50, p < 0.001) by the sixth postoperative month and to 0.52 LogMAR (20/65, p < 0.001) at the last follow-up visit. Graft failure rate was 29.8{\%}. Kaplan-Meier analysis found a 67.2{\%} graft survival rate at 20 months. Conclusions: Complex DSEK can be performed successfully with an acceptable postoperative complication rate by cornea fellows during their training period when supervised by an experienced attending.",
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