PURPOSE: To compare outcomes and complications of Descemet stripping automated endothelial keratoplasty (DSAEK) in complicated cases with intraocular lens (IOL) exchange, aphakia, or anterior chamber intraocular lens (ACIOL) implants with a group of noncomplicated DSAEK cases. METHODS: Of the 30 complicated DSAEK cases, 14 eyes underwent concurrent IOL exchange, 5 ACIOLs were not removed, 5 eyes remained aphakic, and 5 eyes had IOL exchange done before or after DSAEK. One eye had an iris-supported phakic IOL removed, followed by cataract extraction with IOL implantation at the time of DSAEK. The comparison group included 109 consecutive DSAEK cases with a history of Fuchs dystrophy or pseudophakic bullous keratopathy. RESULTS: In the complicated group with significant ocular comorbidities, 27.6% achieved best-corrected visual acuity (BCVA) ≥20/40 and 60% had a final BCVA ≥20/70. In the comparison group of patients without visually significant comorbidities, 94.4% of eyes achieved BCVA ≥20/40 with no complication of graft detachments. Of the 30 complicated eyes, 5 (16.7%) had graft detachments and 5 (16.7%) developed IOL dislocations. All grafts remained clear at the last follow-up visit, except 3 cases (10%) in the complicated group, 2 of which were because of primary graft failure and required penetrating keratoplasty. CONCLUSIONS: In comparison with uncomplicated DSAEK cases, higher graft and IOL dislocations were observed in cases involving IOL exchanges, ACIOLs, or aphakia.
PURPOSE: To compare outcomes and complications of Descemet stripping automated endothelial keratoplasty (DSAEK) in complicated cases with intraocular lens (IOL) exchange, aphakia, or anterior chamber intraocular lens (ACIOL) implants with a group of noncomplicated DSAEK cases. METHODS: Of the 30 complicated DSAEK cases, 14 eyes underwent concurrent IOL exchange, 5 ACIOLs were not removed, 5 eyes remained aphakic, and 5 eyes had IOL exchange done before or after DSAEK. One eye had an iris-supported phakic IOL removed, followed by cataract extraction with IOL implantation at the time of DSAEK. The comparison group included 109 consecutive DSAEK cases with a history of Fuchs dystrophy or pseudophakic bullous keratopathy. RESULTS: In the complicated group with significant ocular comorbidities, 27.6% achieved best-corrected visual acuity (BCVA) ≥20/40 and 60% had a final BCVA ≥20/70. In the comparison group of patients without visually significant comorbidities, 94.4% of eyes achieved BCVA ≥20/40 with no complication of graft detachments. Of the 30 complicated eyes, 5 (16.7%) had graft detachments and 5 (16.7%) developed IOL dislocations. All grafts remained clear at the last follow-up visit, except 3 cases (10%) in the complicated group, 2 of which were because of primary graft failure and required penetrating keratoplasty. CONCLUSIONS: In comparison with uncomplicated DSAEK cases, higher graft and IOL dislocations were observed in cases involving IOL exchanges, ACIOLs, or aphakia.
Authors: Anthony J Aldave; Mark A Terry; Loretta B Szczotka-Flynn; Wendi Liang; Allison R Ayala; Maureen G Maguire; Robert C O'Brien; Beth Ann Benetz; John E Bokosky; Steven P Dunn; Thomas E Gillette; Kristin M Hammersmith; David R Hardten; Bennie H Jeng; Marc F Jones; Richard L Lindstrom; Kenneth J Maverick; Verinder S Nirankari; Matthew S Oliva; Irving M Raber; Christopher J Rapuano; George O D Rosenwasser; Kevin W Ross; John W Seedor; Neda Shamie; Christopher G Stoeger; Shachar Tauber; Woodford S Van Meter; David D Verdier; Jonathan H Lass Journal: Am J Ophthalmol Date: 2019-03-06 Impact factor: 5.258