Transcript Early Outcomes of DSAEK in Pseudophakic Eyes with Anterior

Early Outcomes of DSAEK in
Pseudophakic Eyes with Anterior
Chamber IOLs
Hong A, Boehlke CS,
Afshari NA, Kim T
Duke University Medical Center
Authors have no financial interest
Background
• DSAEK has significant advantages over
standard penetrating keratoplasty in the
management of corneal endothelial disorders
– Faster Visual Rehabilitation
– More predictable corneal power
– Preserves the structural integrity of the eye
– Decreased suture-related complications
• This technique has gained widespread popularity
for use in phakic and pseudophakic eyes with
posterior chamber IOLs
• The role of DSAEK in eyes with anterior chamber
IOLs (ACIOLs) remains unclear
– Generally considered a surgical contraindication due
to higher risk of surgical complications and graft
failure
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Reduced space in the anterior chamber
Escape of air posteriorly through the peripheral iridectomy
Greater potential for vitreous interference
Possibly greater surgical manipulation of donor tissue
– May necessitate an IOL exchange (iris- or scleralsutured IOL)
Purpose
• To report on the early results of DSAEK in eyes
with pre-existing ACIOLs
• To evaluate the visual outcomes, refractive
changes, and complications in this patient
population
Methods
• Retrospective case study
• Nine eyes of 9 patients with ACIOLs that subsequently
developed corneal edema requiring DSAEK were
identified from May 2005 to February 2008.
• The host Descemet membrane was stripped followed
by insertion of a microkeratome-dissected donor
endothelial graft that was delivered through a 3-mm
corneal incision. Donor adherence to the host cornea
was maximized by air tamponade and graft interface
venting incisions.
• Best spectacle-corrected visual acuity (BSCVA),
manifest refraction, donor dislocation and graft failure
rates were measured up to 12 months after DSAEK.
Preoperative Clinical Data
Mean Age (yrs)
71.2 ± 10.8 (range 53 to 84)
Male: Female
7:2
Indications
Pseudophakic bullous keratopathy: 8
Recent failed penetrating keratoplasty: 1
Fuchs’ corneal dystrophy: 1
Preoperative comorbidities
Chronic CME: 1
Advanced Retinitis Pigmentosa: 1
Open-angle glaucoma: 6
Anterior chamber glaucoma tube: 1
Pars plana glaucoma tube: 1
Refractive Outcomes
Preoperative
Postoperative
P-value
Mean spherical
equivalent (D)
0.26 ± 1.6
0.05 ± 1.4
0.26
Mean refractive
astigmatism (D)
2.4 ± 1.7
1.6 ± 1.5
0.50
Postoperative refractive status was obtained at 3 to 6 months
D = diopters; n = 8
Visual Outcomes and Comorbidities
Patient
No.
Preoperative
BSCVA
Postoperative
BSCVA
Comorbidity
1
20/200
20/70
Chronic CME, glaucoma
2
20/200
20/40
Prior penetrating keratoplasty
3
20/200
20/50
Glaucoma, pars plana glaucoma tube
4
20/60
20/30
Glaucoma
5
20/200
20/50
6
Count Fingers
20/40
Glaucoma
7
20/400
20/60
Retinitis pigmentosa, AC glaucoma tube
8
20/200
20/60
Glaucoma
9
20/100
20/50
Mean
20/200
20/50
p=0.0007
BSCVA = best spectacle-corrected visual acuity; AC = anterior chamber
Postoperative BSCVA = obtained at 3 to 6 months
Complications
Complication
No. of Patients
(%)
Donor dislocation, requiring repositioning
2 (22.2%)
Primary graft failure, requiring repeat DSAEK*
2 (22.2%)
Pupillary block glaucoma
n=9
*In one case, the donor tissue had first detached, was repositioned with
repeat air injection, detached again and was regrafted
0 (0%)
Conclusions
• Average visual outcomes of DSAEK in eyes with ACIOLs
may be comparable to vision after DSAEK with
posterior chamber IOLs.
• Patients with ACIOLs may still be good candidates for
DSAEK if they meet the ideal surgical criteria of a deep
chamber, no vitreous interference, absent peripheral
anterior synechiae, and the ability to maintain air
tamponade for a prolonged period
• DSAEK in eyes with ACIOLs can result in excellent visual
outcomes with rapid visual recovery and may eliminate
the need for an IOL exchange