Descemet Stripping Automated Endothelial Keratoplasty in patients with Toxic anterior segment syndrome induced

endothelial failure

First and Presenting author: Jeewan S. TitiyalCo-authors: Tarun Arora, Manpreet Kaur, Tushar Agarwal

Affiliation: RP Centre, AIIMS, New Delhi, India

None of the authors of this poster have any financial interests

Purpose

To evaluate the factors responsible for success and

failure of Descemet Stripping Automated Endothelial

Keratoplasty (DSAEK) in patients with Toxic anterior

segment syndrome (TASS) induced endothelial failure

Methodology

• Type of study: Retrospective case series

• Number of cases = 5

• Inclusion criteria: Patients with endothelial failure as a

result of TASS, post phacoemulsification surgery and

IOP ≤ 24 mm Hg with or without medications

Parameters Evaluated

• Demographic profile

• Preoperative Endothelial count, Central corneal thickness

(CCT), Intraocular pressure (IOP)

• Time interval of DSAEK surgery from onset of TASS

• Intraoperative challenges and complications during

DSAEK surgery

Outcome measures (at

final visit)

• Best-corrected visual acuity

• Intraocular pressure

• Graft clarity

• Donor and host corneal thickness

• Specular count

Results

• Mean (±SD) age was 58.6 (±4.04) years

• Mean (±SD) preoperative CCT was 615.4 (±46.8)

microns

• Mean(±SD) preoperative specular count was

433.4(±40.6) cells/mm2

Results (contd.)• Mean (±SD) follow up was 15.3 (±5.2) months (range 6 – 24 months)

• At final follow up

o Three cases (60%) maintained clear graft with BCVA ≥ 20/40,

mean (±SD) host thickness: 414.3 ± 25.1 microns, mean (±SD)

donor thickness: 140.2 ± 21.1 microns

o Two cases had graft failure with BCVA < 20/200, mean (±SD) host

thickness: 544.2 ± 32.3 microns, mean (±SD) donor thickness:

221.5 ± 42.3 microns and raised IOP (>24m Hg)

Results (contd.)

• Average time interval between episode of TASS and

successful DSAEK surgeries: 126.7 days

• Average time interval between episode of TASS and

failed DSAEK surgeries: 31 days

Patient detailsSerial No.

Age Sex Time Interval between TASS and DSAEK

Graft Clarity

BCDVA

IOP Complications

1 54 M 27 0 PL+ 28 Floppy iris, secondary glaucoma

2 62 M 35 0 PL+ 30 Increased anterior chamber inflammation, secondary glaucoma

3 55 F 120 4 20/30 20 -

4 59 F 128 4 20/30 16 -

5 63 M 132 3 20/40 18 -

Results (contd.)Possible factors for graft failure

• Floppy iris leading to extensive peripheral anterior synechiae,

• Postoperative exacerbated inflammation, pigment release and

• Increased intraocular pressure

Conclusion

Early DSAEK surgery in patients with endothelial failure

as a result of TASS are associated with increased

postoperative inflammation and raised IOP which may

eventually lead to poor outcome of DSAEK surgery

ConclusionDelayed DSAEK surgery after proper control of

inflammation and intraocular pressure leads to excellent

outcomes in cases with endothelial failure due to Toxic

anterior segment syndrome