Surgical outcomes of endothelial keratoplasty safety-basket suture for management of difficult cases

Abstract Objective To report outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) safety-basket suture technique in complex eyes in which an air bubble could not be maintained in the anterior chamber. Study design Retrospective chart review. Participants Patient's undergoing DSAEK with use of the safety-basket suture technique in patients with corneal edema secondary to endothelial dysfunction with up to 3 years of follow-up between 2013 and 2016. Methods Outcome measures were corrected distance visual acuity, average endothelial cell count loss, graft decentration, graft detachment, rebubble rate, infection rate, graft rejection, and graft failure were analyzed. Results The technique was used successfully for 36 high-risk cases with no incidence of graft decentration, postoperative infection, or graft rejection. Both the graft detachment and rebubble rate was found to be 11.1%. The graft failure rate was found to be 22.2% with an average of 3.3 months, with 37.5% of these being primary failure and 62.5% of these being secondary failure. Conclusions Endothelial keratoplasty safety-basket suture is a technique that can be beneficial in difficult DSAEK cases with a lower graft detachment rate compared with the current literature as well as a fairly low complication rate and graft failure while maintaining good visual outcomes. The safety-basket suture is the technique of choice for cases of aphakia and may allow for DSAEK in cases previously that may have only been considered for full-thickness keratoplasty.