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Sophia Mirza, Meenakshi Chaku, Leslie Olsakovsky; Descemet’s stripping automated endothelial keratoplasty and Cataract Surgery: A comparison of Effects on Visual Acuity and IOP between Combined procedures versus DSAEK alone. Invest. Ophthalmol. Vis. Sci. 2012;53(14):55.
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© ARVO (1962-2015); The Authors (2016-present)
To compare outcome measures of best corrected visual acuity and intraocular pressure between patients who underwent Descemet’s stripping automated endothelial keroplasty (DSAEK) with cataract extraction to pseudophakic patients who underwent DSAEK alone.
Thirty seven patients (37 eyes) who underwent DSAEK by a single surgeon between September 2008 and March 2010 were retrospectively reviewed. Two patients groups were established: Those who were already pseudophakic and underwent DSAEK and those were underwent cataract extraction and DSAEK combined. Outcome measures including best corrected visual acuity (BCVA) and intraocular pressure (IOP) were recorded pre-operatively and at 1, 3, 6, 9, and 12 month follow up visits. The results were analyzed.
Twenty one eyes (57%) had DSAEK alone while 16 eyes (43.2%) underwent combined DSAEK-cataract extraction. Sixty-eight percent of DSAEK only patients were female and 34% male. Eighty-one percent of the patients who had combined surgery were female and 19% male. Fuchs’ dystrophy was the diagnosis for surgery in 71% of patients who had DSAEK only group and in 88% of those underwent combined surgery. Twenty-three percent of patients in the combined arm and 18% of those in the DSAEK only arm had a previous diagnosis of glaucoma.Both groups had significant improvement of BCVA at all follow-up visits (p<0.001). The combined arm demonstrated a larger percent change from pre-operative BCVA, and average of 2 lines better BCVA at each time point compared with the DSAEK only arm. An elevated IOP was noted in both groups. For the combined arm, IOP percent change from baseline increased by 15% at 3 months and 30% at 6 months. The IOP remained elevated for the duration of the study. In the DSAEK only arm, IOP percent change from baseline increased by 26% at 3 months and 52% at 6 months. However, at 9 and 12 months, IOP decreased in this patient group.
Following combined DSAEK and cataract extraction, BCVA may improve more than in pseudophakic patients undergoing DSAEK alone. IOP may also increase after DSAEK surgery. This elevation in IOP may be more transient in those undergoing DSAEK alone compared to those that have combined DSAEK surgery with cataract extraction.
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