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J. F. Lever, D. J. Covert, S. B. Koenig; Two Year Results of the New Triple Procedure (Descemet’s Stripping Automated Endothelial Keratoplasty, Phacoemulsification, and Intraocular Lens Implantation). Invest. Ophthalmol. Vis. Sci. 2009;50(13):606.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet’s stripping and automated endothelial keratoplasty combined with phacoemulsification and posterior intraocular lens (IOL) implantation (DSAEK-phaco) has been described as a viable and potentially preferred approach to penetrating keratoplasty in treating patients with coexisting cataracts and Fuchs endothelial dystrophy. Short term results have documented rapid visual rehabilitation and predictable refractive outcome. The purpose of this study is to report the 2 year visual and refractive outcomes of the new triple procedure, DSAEK-phaco.
Prospective, IRB approved case series of 61 eyes of 47 patients that underwent DSAEK-phaco by a single surgeon (SBK) at a single institution. Best spectacle-corrected visual acuity (BSCVA), refractive status, and keratometry were measured preoperatively and at 6, 12, 18 and 24 months postoperatively.
A total of 61 eyes of 47 patients were included. Average age at time of surgery was 70.9 years. Follow up ranged varied as follows: 6 months: 61 eyes; 12 months: 51 eyes; 18 months: 18 eyes; and 24 months: 18 eyes. The average preoperative BSCVA was 20/73; this was statistically different from that at 6 months (20/37), 12 months (20/34), 18 months (20/29), and 24 months (20/29) (p<0.0001 for each). Average preoperative refractive spherical equivalent was -0.53 D (SD: 3.0 D) compared to 0.05 D at 6 months, 0.04 D at 12 months, 0.27 D at 18 months and 0.16 D at 24 months. A slight hyperopic shift of 0.69 D was noted between 6 months and 12 months by paired samples analysis (p<0.0001). Average preoperative keratometric astigmatism was 1.7 D and was not statistically different at any time postoperative point (p>0.15 for each). The average error of predicted refraction was 1.17 D at 6 months and remained stable at 12, 18, and 24 months by the paired samples t-test (p=0.63, 0.96, 0.60, respectively).
In this series, the new triple procedure yields stable visual results, predictable spherical equivalent refractive outcomes, and has no observed effect on keratometric astigmatism through 2 years of follow up.
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