Use of a Novel Y- Suture Technique to Reduce Detachments in Descemet

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Use of a Novel Y- Suture Technique to Reduce
Detachments in Descemets Stripping Automated
Endothelial Keratoplasty (DSAEK)

• Habeeb Ahmad, MD
• Martin Heur, MD, PhD
• Sam Yiu, MD
• Jonathon Song, MD
• Ronald Smith, MD

The authors have no financial interest
in the subject
matter of this poster
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Introduction Advantages of DSAEK

• DSAEK vs. Penetrating Keratoplasty
• Avoids open sky surgery
• Faster recovery time
• Less sutures reduced astigmatism,
• smoother anterior surface, less suture
• related complications
• Improved tectonic stability
• Reduced graft failure from ocular surface
• Small refractive shift/Good visual
• outcomes

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The Rise of DSAEK
2006- 6,027 tissues provided for Endothelial
Keratoplasty(EK) procedures
?134 2007- 14,159
tissues provided for Endothelial
Keratoplasty procedures
?30 2008- 18,375 tissues provided for
Endothelial Keratoplasty
procedures 2007- 85 of all transplants for
endothelial disease were EK
surgical procedures 2008- Total transplants rose
5.7 (39,391?41,652)
Eye Bank Association of America Statistics
Report 2008
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DSAEK Limitations in the Literature

• Posterior Graft Dislocation
• (0-82, average 14.5)
• Endothelial Cell Loss
• (1 year Postoperatively 24 - 61)
• Primary Graft failure
• (0-29)
• Pupillary Block/Steroid Induced
• Glaucoma
• (0-15)
• Hyperopic Shift
• (0.7D - 1.5D, mean 1.1D)

Lee et al. Descemets Stripping Endothelial
Keratoplasty Safety Outcomes. Ophthalmology
20091161818-1830
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Purpose
To find a method to reduce/prevent lenticule
detachments, particularly, in high risk patients
including those with associated aphakia,
glaucoma, blebs, tubes, iris abnormalities and
vitreous in the AC. Ideal method would be 1-
Safe 2- Repeatable 3- Technically simple 4- Carry
low risk of infection 5- Avoid gross manipulation
of graft 6- Achieve anatomic and visual
success 7- Reversible 8- Inexpensive
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Methods

• Retrospective review
• 26 non-consecutive DSAEK procedures using Y-
  suture technique
• Timeframe 2007- 2009
• Performed by three surgeons at the university
  hospital setting
• Patient demographics
• 25 Patients 12 Males, 13 Females
• Ages Range 27 - 95
• Mean Age 69

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Introduction to the Y-Suture Technique

• 3 Anchoring Sutures
• in Y Formation
• Full thickness,
• Peripheral,
• Tangential, Used to
• tether small portion
• of lenticule
• Performed after
• placing air bubble
• Using 10.0 Nylon
• sutures
• Knots are not buried
• Removed after 1 week

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Demographic Results
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Color Slit Lamp Photo 1 week after Y-Suture
DSAEK
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Results Y-Suture DSAEK in High Risk Patients
97
3
0
0
0
Fully Attached Grafts
Dislocated Grafts
Primary Graft Failure
Graft Rejection
Suture Related Complications
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Anterior Segment OCT of the onlydislocation in
the study group. Dislocation was a result of a
severe hypotony with bleb leak
2
1
Suture
Two months later fully dislocated graft
Sutured graft with interface fluid
4
3
Graft remains well adhered months later
Repeat DSAEK after revision of bleb
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Conclusions

• DSAEK surgery when successful, results in
  excellent visual outcomes
• In high risk patients (glaucoma, previous
  dislocations, iris abnormalities, vitreous in
  AC), graft detachment can be significantly higher
  than typical patients limiting both surgical and
  visual success
• Use of the Y suture technique during DSAEK is an
  effective, safe, reproducible and inexpensive
  mean to reduce detachments in these high risk
  patients