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