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Surgeon offers pearls for performing EK in complicated eyes
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CHICAGO — Performing endothelial keratoplasty in complicated eyes can still be safe and effective as long as surgeons take the necessary precautions, a surgeon said here.
 William Barry Lee |
Speaking here at Cornea Subspecialty Day preceding the joint meeting of the American Academy of Ophthalmology and the Middle East Africa Council of Ophthalmology, William Barry Lee, MD, discussed pearls for optimizing EK outcomes in a number of complex situations.
For EK cases when simultaneous cataract surgery is required, Dr. Lee recommended aiming for a –1.25 D target refraction with the IOL, and using viscoelastic and trypan blue for improved visibility.
In glaucomatous eyes, EK may require tube shunt obstruction and the use of sutures with 100% air fill after surgery, he said.
For EK after complicated cataract surgery, Dr. Lee advised checking all incisions closely for retained vitreous in the anterior chamber and being prepared to perform vitrectomy, IOL exchange or iris/scleral fixation.
In eyes implanted with anterior chamber IOLs, Dr. Lee recommended using Miochol-E (acetylcholine chloride, Bausch + Lomb) to constrict the pupil. He also recommended paying close attention when closing the paracentesis and main incision.
"I would encourage you to still try these challenging cases," Dr. Lee said. "And you always have the penetrating graft to fall back on."
- Disclosure: Dr. Lee has received lecture fees, travel fees or reimbursements for speaking for Bausch + Lomb Surgical.
Dr. Lee outlined several of the complex conditions in which endothelial keratoplasty may be performed. I completely agree that endothelial keratoplasty may be possible under a diverse group of challenging circumstances. However, enthusiasm for complex surgery should be tempered by an increased risk of complications, most notably the donor not attaching. In my experience, a shallow anterior chamber with limited visibility remains my greatest challenge, but as Dr. Lee pointed out, “you always have the penetrating graft to fall back on.” In addition, these challenging cases for endothelial keratoplasty are often challenging cases for penetrating keratoplasty, with an increased risk of rejection and worsening of glaucoma. I would suggest the novice endothelial keratoplasty surgeon start with the simple cases, but once they gain experience, the complex cases Dr. Lee suggested may be among the most rewarding surgeries we perform.
— Eric D. Donnenfeld, MD
OSN U.S.
Edition Cornea/External Disease Board Member
Disclosure: Dr. Donnenfeld is
a consultant for Bausch + Lomb.