الفهرس 
Introduction and Aim of the workOnly 14 pages are availabe for public view
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Abstract
Endothelial keratoplasty (EK), also referred to as posterior lamellar keratoplasty, is a form of corneal transplantation in which a donor posterior corneal button, including donor corneal endothelium, Descemet’s membrane, and posterior corneal stroma, is used for selective replacement of diseased corneal endothelium in conditions characterized by corneal endothelial dysfunction.
Descemet’s stripping (automated) endothelial keratoplasty (DSEK) has become the most widespread variation of EK surgery performed by corneal surgeons across the world because of the straightforward automated preparation of the donor tissue performed increasingly by eye banks, extensive DSEK educational courses and scientific meeting presentations, and a growing body of peer-reviewed DSEK literature.
We performed an institutional review board-approved prospective study of a surgical case series of 48 eyes at Doheny Eye Institute undergoing DSEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy with or without simultaneous phacoemulsification and intraocular lens implantation from July 2009 to March 20 II.All patients received informed consent and signed a surgical consent form. Patients with coexisting age-related macular degeneration (AMD), primary open-angle glaucoma, epiretinal membrane, or dense stromal opacities were excluded from this study.
The entire group experience improvement in Snellen BSCV A by three lines at 3 months, 2 lines at 6 months and I line at 12 months postoperatively. Fifty-two
Summary & Conclusions
percent of these eyes obtained a vision of 20/40 or better at 6 months and Seventyyfive percent of eyes obtained a vision of 20/40 or better at 12 months.
After DSEK surgery, in the overall group (n =48), 73% of eyes were within 1 D of emmetropia and 95% of eyes were within 2 D of emmetropia and a significant change in SE in DSEK only group with a mean hyperopic shift of 0.6 D.
Graft clarity or graft survival was not typically reported for DSEK, as it often is for PK, for a number of likely reasons. The visual acuity after EK improves and stabilizes much faster than that after PK, so visual acuity data appear early, eliminating the need to report graft clarity or survival that may be used as a proxy for graft function in the absence of meaningful acuity data. The absence of significant postkeratoplasty astigmatism, fewer corneal surface issues, and no corneal suture issues with DSEK, compared with PK, all contribute to early emergence of data on visual acuity and refractive error in DSEK. In our study the entire group corneas (n=48) remain clear at 6 and 12 months postoperatively (including cases that underwent repeat DSEK after primary graft failure), reflecting survival rate of 100% at 6 and 12 months postoperative.
In our study there was 16.65% rate of donor dislocation all dislocated donors were reattached successfully with 1 air bubble application after surgery, and application of 3 nylon 10/0 sutures in Y-shaped manner, 3 grafts have remained clear but 5 grafts never cleared for 2 weeks (primary graft failure) which were treated by repeat DSEK.
Endothelial rejection develops in grafts that previously were clear after DSEK surgery, unlike primary graft failure. They represent the host’s immunologic reaction directed against the foreign antigen of the donor corneal tissue. In our study there were 2 (4.16%) cases of graft rejection in the entire series of 48 eyes,