Reducing DSEK Complications with Dr. Francis Price
Reducing DSEK Complications with Dr. Francis Price
Dr. Francis Price describes the secrets behind his very low DSEK dislocation rate in a conversation with OphthalmologyWeb contributing editor Dr. Clark Springs. Some of the pearls: Incision size matters (4 to 5 mm). Minimizing donor tissue damage using Ogawa forceps. Dr. Busen's "glider" funnel introducer. Clear corneal incisions are optimal with forceps technique vs. scleral tunnel. This may not be the case with the funnel technique. Anterior chamber maintenance with BSS and 23 gauge needle during the Descemet’s stripping. Recently been using VSDs but the drawbacks are that an I/A tip is in the field and residual VSDs may interfere with donor adhesion. Vision Blue (DORC) is a good contrast agent. Air is perhaps optimal during the stripping of Descemet’s. AC maintenance once the donor tissue is in place is not used, except with the Busen glide is being used. Precut vs. Surgeon cut comparison - same in his study of 40 cases (20 each). Typically though, they cut their own tissue. 9mm donor is their preferred size. Anesthesia techniques are also reviewed. Dr. Price also outlines techniques to assure donor tissue adherence and defines his approach for patients with concomitant cataracts. Management of patients with anterior chamber IOLs is reviewed as is trabeculectomy. Eyebank statistics - demographics of transplants: in 2005 EK was 4% of transplants performed. In 2006, 16% of grafts were for EK. 2007 = 37%, showing that DSEK is rapidly increasing. Anterior lamellar keratoplasties will also be increasing in the future as long term data on PK become known.