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Moderator
Yousuf Khalifa, MD, FACS
Panelists
Winston D Chamberlain, MD, PhD, ABO; Seth M. Pantanelli, MD, MS, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Daniela Spies, BA
Co-Authors
Alexandra Gil (BSc), Chase Boehmer (DO), Leslie Vargas (MD), Alexander Gasper (BA), William Trattler (MD)
Purpose
This study evaluates the recurrence rate of pterygium following excision using the Modified Anduze Technique, and compares it to recurrence rates reported for other surgical methods of pterygium excision.
Methods
This retrospective cohort study included 185 eyes that underwent primary or recurrent nasal pterygium excision with the Modified Anduze Technique at a single center. Patients with at least six months of postoperative follow-up were included. The primary outcome was recurrence, defined as fibrovascular tissue invading ?1 mm onto the cornea beyond the limbus after surgery. Recurrence rates were stratified by age group (<40, 40-59, ?60) and gender.
Results
Among 360 eyes, 16 of 360 (4.4%) developed recurrence; however, 175 eyes had <6 months follow-up. In the 185 eyes with ?6 months follow-up (mean 3.7 years; range 6 months-16 years), recurrence occurred in 16 of 185 eyes (8.6%). Recurrence was higher in males (10 of 100, 10.0%) than females (6 of 85, 7.1%). Eyes with prior surgery had a numerically higher recurrence rate (2 of 19, 10.5%) compared to primary excision (14 of 166, 8.4%). Recurrence rates were highest in patients older than 60 years (9 of 91, 9.9%), compared with those aged 40-59 (6 of 73, 8.2%) & under age 40 (1 of 21, 4.8%). Three of 16 eyes with recurrence (18.8%) discontinued topical steroids early due to elevated IOP.
Conclusion
The Modified Anduze Technique achieved a low recurrence rate of 8.6%, demonstrating effective control of pterygium recurrence while preserving conjunctiva & eliminating the need for grafting. This rate compares favorably with published recurrence rates for bare sclera excision (~24-89%), conjunctival autograft (3.3-16.7%), & AMT (6.4-42.3%).
Presenting Author
Rawan s Alshabeeb, MD
Purpose
To assess the visual and clinical outcomes of Endothelial Keratoplasty(EK) for Failed penetrating keratoplasty (PKP)
Methods
A retrospective review of patients who underwent DMEK or DSAEK following failed keratoplasty at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia,between January 2014 and December 2024.Patients who had primary endothelial keratoplasty, re-PKP or lamellar keratoplasty.Data collected on patient demographics, indications for PKP, history of glaucoma,type of endothelial keratoplasty,endothelial graft diameter, graft insertion method, development of graft rejection or failure, and graft survival at final follow-up.Main outcomes measures is graft survival,best corrected visual acuity,and complicationsThe probability of graft survival was calculated using Kaplan–Meier survival analysis.
Results
Fifty-two eyes from 51 patients were included (mean age 55.5 ± 20.8 years). Bullous keratopathy was the most common indication for initial PKP (28.8%),and 13 eyes (23%) had ≥2 prior PKPs. Surgeon-cut DSAEK was performed in 37 eyes (71.2%). Donor graft size was a significant risk factor for failure at 6 months (P=0.048) and 12 months (P=0.023). Bullous keratopathy was a risk factor for failure at 12 months (P=0.038). Mean BCVA improved from 1.6 ± 1.6 to 1.0 ± 1.0 logMAR at 1 year (P<0.001). Kaplan–Meier analysis showed mean survival of 1.9 years and estimated graft survival of 11.9 years.
Conclusion
EK after PK improved visual outcomes with acceptable short-term graft clarity. Donor graft size and bullous keratopathy were associated with graft failure.EK may serve as an alternative to repeat PK for endothelial failure.
Presenting Author
Hyelin You, MD
Co-Authors
Anthony Aldave (MD), Seyed Reza Ghaffari Dehkharghani (MD), Sophie Deng (MD, PhD), Alan Kong (MD), Bryan Zarrin (MD)
Purpose
To identify the predictive risk factors for secondary graft failure (SGF) after Descemet stripping endothelial keratoplasty (DSEK) in eyes with anterior chamber intraocular lenses (ACIOL).
Methods
Retrospective chart review of all patients with a PCIOL or ACIOL who underwent DSEK by two surgeons at the Stein Eye Institute from May 2006 to December 2024. Multivariate Cox regression analysis was performed to identify risk factors for SGF.
Results
740 DSEK procedures were included (132 ACIOL, 608 PCIOL). SGF incidence was 0.134 (ACIOL) vs. 0.054 (PCIOL). Having an ACIOL increased SGF risk in eyes without glaucoma (HR 2.9[1.1-7.8]), trended toward significance in eyes with medically treated glaucoma (HR 2.2[0.9-5.2]), but not in eyes with prior glaucoma surgery (trab HR 1.5[0.5-4.4]; tube HR 0.8[0.4-1.8]). There was no significant difference in post-op IOP elevation, but glaucoma surgery was more common with ACIOL (14.4% vs 6.7%, p< 0.01). There were no significant differences in primary graft failure (1.5% vs 3.5%), graft detachment (9.1% vs 11.7%), endothelial rejection (11.4% vs 10.7%), or mean VA improvement (-0.36 vs -0.41LogMAR).
Conclusion
The presence of an ACIOL increases the risk of SGF after DSEK in eyes without glaucoma and medically treated glaucoma but not in eyes with prior glaucoma surgery. Comparison of DSEK outcomes in eyes with ACIOL vs other secondary IOLs is needed to assess whether ACIOL exchange should precede DSEK in eyes without prior glaucoma surgery.
Presenting Author
Su Kim, MD
Co-Authors
Danielle Trief (MD), George Florakis (MD)
Purpose
To assess the clinical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) under a failed penetrating keratoplasty (PK)
Methods
We performed a retrospective review of 17 eyes of 16 patients who underwent DSAEK under a failed PK between April 2010 and March 2022. We evaluated patients' prior ocular history and compared preoperative and postoperative visual outcomes, including visual acuity, corneal topographic and tomographic parameters, and refractive measurements.
Results
Of 17 eyes, 12 had prior history of cataract surgery. Among 13 eyes with a history of glaucoma, 8 had prior glaucoma surgery. Prior to DSAEK, 8 patients had 2 or more prior corneal transplantations. Preoperative visual acuity ranged from 20/40 to HM. Final visual acuity ranged from 20/20 to CF. Vision improved in 11 eyes and worsened in 3. Preoperative manifest refraction (n=3) had an average spherical equivalent of -4.4D. Postoperative manifest refraction (n=5) had an average spherical equivalent of -2.5D. Mean preoperative K1/K2/Kmax values were 44.0/47.6/58.1. Postoperative values were 44.3 /48.1/55.5.
Conclusion
Patients undergoing DSAEK under failed PK had significant ocular comorbidities. Visual acuity (11 eyes, 65%) and keratometry (6 eyes, 35%) improved in most cases, although worsened visual acuity in 3 eyes (18%), and tomographic astigmatism increased in 5 eyes (29%).
Presenting Author
Eric Abdullayev, MD, MBA
Co-Authors
Benjamin Lambright (MD), Jason Miles (MD), Arthur Kurz (BSc)
Purpose
The specular microscopy, which only captures a limited central area (0.25-0.50 mm). In this study, we present a novel method to assess total endothelial cell loss (ECL) across the entire donor graft immediately after transplantation. This was achieved using a custom-designed module that replicates the recipient eye
Methods
Thirty-five DSAEK grafts were prepared, and baseline ECL was recorded. Grafts were then inserted into the recipient module using one of six techniques: forceps (n=5), preloaded injectable Weiss glass cannula (n=5), two variations of the Busin glide (n=10), Endoglide DSAEK (n=5), Endoserter (n=5), and needle-push (n=5). Following insertion and unfolding, grafts were re-stained and imaged using a novel full-graft imaging technique. The percentage of damaged endothelial cells was quantified using ImageJ software
Results
Mean ECL for each technique was as follows: forceps (23%), Weiss glass cannula (7%), Busin glide (24%), Endoglide DSAEK (13%), Endoserter (17%), and needle push (24%). Median ECL was significantly lower for the Weiss glass cannula (7%) compared to forceps (23%), Busin glide (24%), and needle push (24%) (p < 0.05). No significant differences were observed between forceps, Busin glide, and needle-push methods. The Endoglide DSAEK and Endoserter techniques resulted in comparable ECL rates
Conclusion
This novel method enables quantification of total endothelial cell loss across the entire donor graft. Among the DSAEK methods tested, the preloaded injectable Weiss glass cannula resulted in the lowest ECL, suggesting its superiority in minimizing graft trauma during implantation
Presenting Author
Dilara Altun, MD
Co-Authors
Ozlem Evren Kemer (MD), Emine Esra Karaca (MD)
Purpose
To evaluate the clinical outcomes of pre-Descemet's endothelial keratoplasty (PDEK) in challenging cases by assessing graft survival, corneal clarity, and anatomical recovery using OCT-based analysis.
Methods
Thirty eyes with various ocular risk factors underwent PDEK.At each visit AS-OCT were obtained and analyzed using ImageJ with a standardized macro.The cornea was divided into concentric 500-µm zones,apex to the periphery. Mean gray value (MGV) was quantified per zone and for pupillary-aperture zones. Sequential changes in MGV and corneal thickness were analyzed with clinical outcomes and patient-based follow-up curves were generated to demonstrate recovery over time.MGV was evaluated as a potential parameter to support the objective assessment of corneal clarity to monitor anatomical recovery and to assist in the evaluation of prognosis during postoperative follow-up in challenging cases.
Results
Mean age was 62.2±15.9 years.Twenty-three eyes had a history of pars plana vitrectomy and 4 had previous glaucoma surgery.Patients had scleral-fixated IOLs (n=14),sulcus IOLs (n=7) and in-the-bag IOLs.Rebubbling was required in 8 eyes (mean 1.9±3.4 days), re-PDEK in 11 (92.1±244.6 days) and penetrating keratoplasty (PK) in 1 eye.CCT decreased significantly from 788.2±150.9 µm to 606.7±129.2 µm at final visit (p<0.001).Overall corneal MGV remained stable (96,166 to 96,559; p>0.05),but month-6 peripheral MGV decreased significantly in Zone 9 (106,135 to 90,566; p=0.010) and Zone 10 (96,110 to 83,463; p=0.030). MGV changes were not associated with CCT changes during follow-up (all p>0.05)
Conclusion
In challenging eyes in which PK might otherwise be considered, PDEK achieved marked anatomical improvement with a low conversion rate to PK. Stable MGV in Zones 1–8 despite significant CCT reduction suggests preserved corneal clarity without clinically meaningful haze.Peripheral month-6 MGV reduction may reflect subclinical edema.
Presenting Author
David K. Seo, BSc
Co-Authors
Karanpreet Multani (MD), Kamran Riaz (MD), Ishan Bhanot (BSc, BA)
Purpose
To identify systemic, ocular, and surgical predictors of early (?1 week) versus late (>1 week) graft dislocation after DMEK or DSAEK, and to assess the impact of dislocation timing on postoperative complications and visual recovery.
Methods
Retrospective, single-center, multi-surgeon analysis of 1,355 eyes undergoing endothelial keratoplasty from 2013 to 2022. Graft dislocation was categorized as none, early (?1 week), or late (>1 week). Data included systemic/ocular history, preoperative visual acuity, operative details, postoperative complications and visual acuity, and donor factors. Multivariable statistical analysis assessed outcomes, including risk factors for graft dislocation, postoperative complications, and visual acuity outcomes over 12 months.
Results
Of 1,355 eyes (531 DMEK and 824 DSAEK), 126 (9.3%) had late rebubbling and 67 (4.9%) had early rebubbling. DMEK was more likely to dislocate late, whereas DSAEK was more likely to dislocate earlier (p=0.0004). Air had a greater risk of late dislocation, whereas SF6 had an increased early risk (p<0.0001). Donor diabetes, especially insulin-dependent diabetes, increased dislocation risk (p=0.0004). Both early and late rebubbling were associated with higher rates of persistent detachment (p<0.0001), graft failure (p=0.0002), edema (p<0.0001), and delayed visual recovery (p<0.0001).
Conclusion
Graft dislocation after DMEK and DSAEK is influenced by donor and surgical factors, including tamponade choice and donor diabetes. Recognizing these patterns can help refine surgical planning and follow-up, ultimately leading to improved postoperative outcomes.
Presenting Author
Dominique Geoffrion, MD, PhD
Co-Authors
Louis Racine (MD), Paul Thompson (MD), Samir Jabbour (MD, FRCSC), Georges Durr (FRCSC, MD), Younes Agoumi (MD, FRCSC), Mona Harissi-Dagher (MD, FRCSC), Edmond Sandouk (MD), Clara Serraglio (None), Colin Quan-Nguyen (None), Mary Wang (BSc), Marie-Claude Robert (MD, FRCSC, MSc), Taha Amkadou (None), Shayyan Wasim (MD)
Purpose
To evaluate the impact of glaucoma status and prior glaucoma surgery on graft survival and visual outcomes following Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK).
Methods
This was a retrospective study of 1464 endothelial keratoplasty cases (993 DSAEK, 471 DMEK) from 2010-2024. Eyes were stratified by glaucoma status (no glaucoma, preexisting, or de novo) and prior interventions (selective laser trabeculoplasty (SLT), minimally invasive glaucoma surgery (MIGS), trabeculectomy, and tube shunts). Primary outcome was graft survival, compared with Kaplan Meier analysis. Secondary outcome was best-corrected visual acuity (BCVA), compared with the Kruskal-Wallis H test.
Results
Mean patient age was 69.9 ± 9.9 years, with an average follow-up of 3.6 years (range: 0.5-14.5). The 5-year incidence of de novo glaucoma was similar between DSAEK (6.9%) and DMEK (7.9%). For DSAEK cases, survival rates at 1 and 5 years were 100% and 85% for SLT, 78% and 48% for trabeculectomy, 71% and 26% for MIGS, and 68% and 22% for tubes. Mean DSAEK BCVA (logMAR) at 1 year was 0.2±0.08 for SLT, 0.5±0.1 for trabeculectomy, 0.7±0.6 for MIGS, and 1.2±0.6 for tubes (P=0.132). For DMEK cases, survival at 1 year was 100% for SLT, 66% for MIGS, and 50% for trabeculectomy. Mean DMEK BCVA at 1 year was 0.2±0.0 for SLT, 0.3±0.0 for trabeculectomy, and 0.3±0.0 for MIGS.
Conclusion
Prior glaucoma interventions, particularly trabeculectomy and tube shunts, are associated with reduced graft survival, especially in DSAEK eyes. SLT appears to be associated with more favorable outcomes in both DMEK and DSAEK. These findings may guide surgical planning in patients with concurrent glaucoma and corneal endothelial disease.
Presenting Author
Devon A Hughes, MD
Co-Authors
Seth Pantanelli (MD, MS)
Purpose
To investigate whether the timing of cataract surgery and endothelial keratoplasty (DMEK and DSAEK)—staged versus same-day sequential—impacts the risk of return to the operating room, using data from the TriNetX database.
Methods
A retrospective cohort analysis was performed using the TriNetX research database of de-identified EHR data. Patients aged 18-89 who underwent both cataract and endothelial keratoplasty surgery were identified via CPT codes and grouped by procedure timing: staged vs. same-day sequential. The primary outcome was risk of return to the operating room; the secondary outcome was the number of outpatient return visits in the 3-months following endothelial keratoplasty surgery. Outcomes were assessed using subsequent intraocular procedure codes and outpatient E&M/Eye codes billed within the global period. No randomization or masking was performed. ~ 6000 total patients met inclusion criteria.
Results
Rebubbling within 30 days occurred in 78 patients (6.2%) in the same-day cohort and 74 patients (6.1%) in the staged cohort. The absolute risk difference was 0.1% (95% CI, −1.8% to 2.0%; p=0.93). The risk ratio was 1.01 (95% CI, 0.74–1.38) and the odds ratio was 1.01 (95% CI, 0.73–1.41). Kaplan–Meier survival analysis demonstrated no significant difference in time to rebubbling between cohorts (log-rank p=0.96), with a hazard ratio of 1.01 (95% CI, 0.73–1.39). Survival probability at 30 days was 93.6% in the same-day cohort and 93.6% in the staged cohort. Among patients requiring rebubbling, the mean number of rebubbling events was similar between groups (1.08 vs 1.08).
Conclusion
This TriNetX database analysis demonstrated same-day CEIOL and EK were not associated with a significantly increased risk of return to the OR for rebubbling compared to staged procedures, supporting its continued use in appropriately selected patients without increased postoperative reintervention risk.
Presenting Author
Arun C. Gulani, MD
Co-Authors
Aaishwariya Gulani (MD), Yash Gulani (BA)
Purpose
To revisit hand lamellar keratoplasty, under topical anesthesia, as a simple, brief, and reproducible option for extreme keratoconus. This approach offers a practical alternative to complex keratoplasty procedures, restoring corneal measurability and vision potential.
Methods
A patient with extreme keratoconus, central scarring, and severe thinning (276 µm) presented with keratometry >82 D and functional blindness. The patient underwent hand lamellar keratoplasty under topical anesthesia using a donor lamellar graft to reinforce corneal structure and reduce curvature. Evaluations included UCVA, BCVA, keratometry, pachymetry, and corneal topography.
Results
The procedure was brief, safe, and well tolerated under topical anesthesia. Keratometry decreased dramatically from 82.3 D to 45.05 D (? -37.25 D). The cornea shifted from scarred and unmeasurable to structurally sound and optically measurable, with significant visual improvement. This outcome positioned the patient for staged excimer laser vision rehabilitation to achieve an unaided visual endpoint
Conclusion
Hand lamellar keratoplasty as a brief and topical procedure with its universal applicability and easy adaptability, demonstrates how eye surgeons can be empowered to manage even extreme Keratoconus and restore vision potential without resorting to invasive corneal transplants.
