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Cataracts common after phakic DSAEK in eyes with corneal decompensation
Cornea. 2011;30:291-295.
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Visually significant cataracts are common after phakic Descemet's stripping automated endothelial keratoplasty in eyes with corneal decompensation, a study found.
In the retrospective case review, researchers evaluated 12 consecutive eyes with corneal decompensation secondary to Fuchs' endothelial dystrophy that underwent DSAEK without crystalline lens removal.
Of the 10 eyes that completed 12 months of follow-up, four experienced visually significant cataracts that required surgery. These eyes showed a significant difference in anterior chamber depth when compared with eyes that did not develop cataracts (P = .005).
Three of the cataractous eyes had a preoperative anterior chamber depth of less than 2.80 mm, which was associated with the resulting cataracts, according to the study. In addition, these eyes developed pupillary blocks with elevated IOP in the first 24 hours after surgery.
The six eyes that did not develop cataracts in the 12-month follow-up period had a mean best corrected visual acuity of 20/24 at 24 months, while the four eyes that developed cataracts had a BCVA of 20/35.
One eye required additional DSAEK after endothelial graft failure.
Although the study authors said the results are promising, performing DSAEK without removal of the crystalline lens should be reserved for patients who are younger than 50 years, have an adequate anterior chamber depth, and have a refractive error that is capable of rehabilitation.
The study authors retrospectively assessed 10 patients with Fuchs’ dystrophy and clear lenses who underwent DSAEK without removal of the crystalline lens. They reported that 40% of patients developed cataract within the first postoperative year and 30% developed pupillary block. Furthermore, they advised against performing phakic DSAEK surgery in eyes that have an anterior chamber depth of less than 3 mm, and they now always perform an inferior peripheral iridotomy in phakic DSAEK to prevent pupillary block. We agree that phakic patients have a high incidence of cataract progression following DSAEK and that pupillary block in these patients may be a vision threatening complication. For this reason, we prefer to perform a DSAEK triple in patients who have any degree of incipient cataract.
– Eric D. Donnenfeld, MD
OSN
Cornea/External Disease Board Member
– Allon Barsam, MD
Cornea/External
Disease/Refractive Surgery Fellow
Disclosures: Drs. Donnenfeld and Barsam
have no relevant financial disclosures.