Risk factors for graft dislocation following Descemet's stripping endothelial keratoplasty

Purpose: The purpose of this study is to determine if patient or donor cornea characteristics are predictive of graft dislocation following endothelial keratoplasty in a teaching institution. Methods: This case-control study was a retrospective chart review of 194 Descemet's stripping endothelial keratoplasty (DSEK) surgeries performed using a single technique. Data collected for evaluation of dislocation rate included patient demographics, etiology of endothelial dysfunction, past ocular history (specifically extent and location of iris abnormalities and lens status), donor age, donor tissue endothelial cell count, donor tissue time from death to preservation, and donor tissue time from death to surgery. Results: When the patients with risk factors for posterior bubble dislocation were combined (anterior chamber intraocular lens, aphakia, and superior iris defects), there was a significant increase in dislocation of the graft (47.83% vs. 19.05%, P = 0.0064). Average time from tissue donor death to DSEK surgery was also significant, with the dislocations having a mean time of 106.65 hours and the controls having a mean of 94.01 hours (P = 0.0162). When evaluating surgeries with an elapsed time of 6 days (n = 5), all five grafts dislocated. Conclusions: Findings in this group of patients would support further study of outcomes of grafts with death to surgery intervals greater than 5 days. Iris anatomy and intraocular lens status should be considered during patient counseling and surgical planning, and donor age should not be a factor in selecting suitable donor tissue for transplantation.