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. 2018 Oct 30;18(1):281.
doi: 10.1186/s12886-018-0946-4.

Outcomes of complex Descemet Stripping Endothelial Keratoplasty performed by cornea fellows

Jacquelyn Daubert  1 , Terrence P O'Brien  1 , Eldad Adler  1 , Oriel Spierer  2   3
Affiliations

Outcomes of complex Descemet Stripping Endothelial Keratoplasty performed by cornea fellows

Jacquelyn Daubert et al. BMC Ophthalmol. .

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.

Keywords: Cornea fellows; DSEK; Descemet Stripping Endothelial Keratoplasty; Ophthalmology fellowship training.

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Conflict of interest statement

Ethics approval and consent to participate

The study adhered to the tenets of the Declaration of Helsinki and was approved by the Institutional Review Board of the University of Miami. As this is a retrospective study, the need for consent for participation is deemed unnecessary according to national regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Kaplan-Meier analysis showing the time to graft failure. At 2 months, 2 grafts failed. At 3 months, 5 grafts failed. At 4 months, 1 graft failed. At 5 months, 4 grafts failed. At 6 months, 2 grafts failed. At 8 months, 1 graft failed. At 17 months, 2 grafts failed
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