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Early DSEK improves vision in post-cataract corneal edema

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PHILADELPHIA — Early Descemet’s stripping endothelial keratoplasty significantly improved visual acuity in eyes that developed pseudophakic bullous keratopathy after cataract surgery, according to a study presented at the Wills Eye Alumni Conference.

“A statistically significant relationship was found between the [corneal edema] to DSEK time and post-DSEK visual acuity. Post-DSEK visual acuity was not associated with the preoperative vision or pachymetry. Performing earlier DSEK for patients with pseudophakic corneal edema may be associated with improved visual outcomes,” Sarah B. Weissbart, MD, said.

The retrospective study included 120 patients who underwent cataract surgery, developed pseudophakic bullous keratopathy and subsequently underwent DSEK. Visual outcomes were assessed 6 months after DSEK.

Mean visual acuity improved from about 20/115 preoperatively to about 20/36 after DSEK.

The interval between the development of corneal edema and DSEK surgery was closely associated with postoperative visual acuity, Weissbart said.

“As the interval between cataract surgery and DSEK increased, postoperative visual acuity worsened,” she said. “When we compared patients who underwent earlier vs. later DSEK surgery, there was no difference in preoperative pachymetry values, but there were significant differences found in both the preoperative and postoperative visual acuities.”

The mean interval between corneal edema and DSEK was 11.7 months in patients with better post-DSEK vision and 21.5 months in patients with worse post-DSEK vision, Weissbart said.

For every 1-month increase in corneal edema to DSEK time, patients were 4% less likely to achieve postoperative visual acuity of 20/40 or better, and patients were about 2.6 times more likely to have better visual acuity if they underwent DSEK within 6 months of cataract surgery, she said. – by Matt Hasson

Reference:

Weissbart SB. Influence of early EK on visual outcomes in patients with PBK. Presented at Wills Eye Alumni Conference; March 10-12; Philadelphia.

Disclosure: Weissbart reports no relevant financial disclosures.