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DSAEK similarly safe in eyes with anterior chamber, posterior chamber IOLs
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Descemet’s stripping automated endothelial keratoplasty yielded comparable results in eyes with anterior chamber and uncomplicated posterior chamber IOLs, according to a study.
The retrospective study included 11 patients with retained anterior chamber IOLs who underwent DSAEK, as well as a control group of 50 patients with posterior chamber IOLs who also underwent DSAEK.
Mean patient age was 79.3 years in the study group and 78.6 years in the control group.
Researchers evaluated uncorrected and corrected visual acuity, manifest refraction, biomicrocopy, IOP, fundus imaging and endothelial cell density. Mean follow-up was 19.4 months in the study group and 18.1 months in the control group.
No complications were seen in the study group, and two cases of mild intraoperative hemorrhage were reported in the control group. Neither pupillary block nor postoperative infection occurred in either group, according to the researchers.
Graft dislocation occurred in one patient in the study group (9%) and in nine patients (18%) in the control group, and all but one instance was resolved with rebubbling.
Postoperative best corrected visual acuity was 1.50 in the study group and 1.02 in the control group and improved to 0.97 in the study group and 0.57 in the control at follow-up; however, between-group differences were considered statistically insignificant.
Endothelial cell loss was 47% in the study group and 39% in the control group at 6 months, and 49% in the study group and 56% in the control group at 9 to 15 months; between-group disparities were insignificant, according to the researchers.
Disclosure: The authors have no relevant financial disclosures.
Perspective
Back to TopMarianne O. Price, PhD
There’s no question that Descemet’s stripping automated endothelial keratoplasty can be performed in eyes with retained anterior chamber IOLs (AC-IOLs) when the anterior chamber is sufficiently deep and the lens is well-centered. The concern is long-term graft survival. So far, the mean follow-up has been 2 years or less in published DSAEK series in eyes with a retained AC-IOL. In studies with 5- to 10-year follow-up, such as the Cornea Donor Study and a 10-year study from our center, penetrating keratoplasty graft survival was significantly curtailed in eyes with a retained AC-IOL. Therefore, we prefer to exchange the AC-IOL for a posterior chamber IOL (PC-IOL) using the intrascleral haptic fixation (glued IOL) technique a month or so before performing endothelial keratoplasty. In some cases, the cornea cleared after exchange of the AC-IOL for a PC-IOL, and the endothelial keratoplasty was no longer necessary.
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