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Priscilla G. Fowler, Viral V. Juthani, Parveen K. Nagra, Kristin M. Hammersmith, Christopher J. Rapuano; Comparison of Combined and Sequential Descemet’s Stripping Endothelial Keratoplasty and Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):54.
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The objective of this study is to investigate the complication rates as well as visual and refractive outcomes of combined Descemet’s stripping endothelial keratoplasty (DSEK), cataract extraction, and intraocular lens implantation (DSEK triple procedure) compared to cataract surgery alone followed by DSEK (sequential surgery).
A retrospective chart review of patients undergoing pseudophakic DSEK and DSEK triple procedures at one institution was performed. 276 eyes of 217 patients were identified as having undergone either pseudophakic DSEK or DSEK triple procedure from January 2007 to present. Data collected included operative eye, age of the patient, pre- and post-operative BCVA, date of procedure performed and length of follow up period, presence and timing of graft dislocation, methods and success of graft repositioning, need for repeat DSEK, episodes of graft failure or rejection, and the presence or absence of other co-morbid ocular conditions and their possible effect on clinical outcomes. Patients with previous glaucoma filtering surgeries or drainage devices, ACIOL’s, or previous vitrectomy surgery were excluded from this analysis.
A comparison of 50 uncomplicated DSEK in 32 patients to 50 uncomplicated DSEK triples in 42 patients revealed 3 graft dislocations (6%) in the pseudophakic DSEK group and 8 dislocations (16%) in the DSEK triple group (p=0.11). Rejection occurred in 1 eye (2%) in the pseudophakic DSEK group and 5 eyes (10%) in the triple group (p=0.09). There was a 4% graft failure rate in both groups. BCVA was recorded when available pre-operatively and at 3 months, 6 months, and one year or most recent follow up post-operatively. The pseudophakic DSEK group had an average improvement of 2.73 lines of snellen acuity (n=38, range 0-8 lines) as compared to 3.39 lines (n=41, range 0-9 lines) in the DSEK triple group.
In our analysis of pseudophakic DSEK and DSEK triple procedures, the rates of dislocation and rejection were slightly higher in the DSEK triple group. Both groups had an equal graft failure rate. The amount of improvement in vision was slightly greater in the DSEK triple group and most likely is related to the contribution of the cataract to visual dysfunction. Although our data is not statistically significant, it demonstrates potential trends that warrant further study.
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