DSAEK- Postoperative Positioning and Transplant Dislocation
Study Details
Study Description
Brief Summary
Corneal transplant is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft) in its entirety (penetrating keratoplasty) or in part (lamellar keratoplasty). One type of lamellar keratoplasty is DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty), where only the damaged posterior section of the cornea is replaced.
The purpose of this study is to investigate how immediate postoperative positioning of the patient affects the dislocation rate of the corneal graft. Since this is a new surgical method, little scientific documentation has been published in this area.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Corneal transplant is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft) in its entirety (penetrating keratoplasty) or in part (lamellar keratoplasty). One type of lamellar keratoplasty is DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty), where only the damaged posterior section of the cornea is replaced.
To get the graft in the right position inside the eyes anterior chamber, the anterior chamber is fully filled with air, and the patient is placed in a supine position looking facing up for different amount of time depending on the surgeon. In this way the air bubble will press the graft in the right position and prevent dislocation. Our experience is that since the anterior chamber of the eye already is fully filled with air, it does not matter how the patient is positioned postoperatively regarding graft dislocation.
Our hypothesis is that the immediate postoperative positioning is insignificant. If this can be significantly proved this may enhance the patients comfort postoperatively.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Other: Postoperative positioning: Bed rest Patients in this group must be lying down facing up 2 hours postoperatively |
Other: Postoperative positioning: Bed rest
Patients in this group should be lying down facing up 2 hours postoperatively
|
| Other: Postoperative positioning: Sitting up Patients in this group should be sitting up in a chair 2 hours postoperatively |
Other: Postoperative positioning: Sitting up
Patients in this group should be sitting up in a chair 2 hours postoperative
|
Outcome Measures
Primary Outcome Measures
- Graft dislocation measured by slit lamp examination [5 years]
Graft dislocation is checked 2 hours postoperatively, they day after the surgery, 1 week after, 1 month, and then every 3. month for 1 year, and then every 6. months for 5 years.
Secondary Outcome Measures
- Intraocular pressure (IOP) [5 years]
The intraocular pressure (IOP) is measured at every postoperative control
- Visual Acuity [5 years]
Visual Acuity is measured at every postoperative control
- Endothelial cell count of the graft [5 years]
Endothelial cell count of the graft is measured at every postoperative control
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Corneal dystrophy requiring corneal transplantation
-
Patients written permission
-
Pseudophakia
Exclusion Criteria:
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Uncontrolled glaucoma
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Phakia or aphakia
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Shallow anterior chamber
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Fibrotic cornea
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Demented patients
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Claustrophobic patients
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Patients that do not want to participate
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Departement of Ophthalmology, Oslo University Hospital, Norway | Oslo | Norway | N-0407 |
Sponsors and Collaborators
- Oslo University Hospital
Investigators
- Study Director: Liv Drolsum, Prof.,MD,PhD, Department of Ophthalmology, Oslo University Hospital, Norway
Study Documents (Full-Text)
None provided.More Information
Publications
- Dapena I, Ham L, Melles GR. Endothelial keratoplasty: DSEK/DSAEK or DMEK--the thinner the better? Curr Opin Ophthalmol. 2009 Jul;20(4):299-307. doi: 10.1097/ICU.0b013e32832b8d18. Review.
- Price MO, Giebel AW, Fairchild KM, Price FW Jr. Descemet's membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival. Ophthalmology. 2009 Dec;116(12):2361-8. doi: 10.1016/j.ophtha.2009.07.010. Epub 2009 Oct 28.
- Price MO, Gorovoy M, Benetz BA, Price FW Jr, Menegay HJ, Debanne SM, Lass JH. Descemet's stripping automated endothelial keratoplasty outcomes compared with penetrating keratoplasty from the Cornea Donor Study. Ophthalmology. 2010 Mar;117(3):438-44. doi: 10.1016/j.ophtha.2009.07.036. Epub 2010 Jan 19.
- 239-08/344c(REK)-1