Abstract
Purpose: :
To evaluate endothelial cell density (ECD), pachymetry, graft clarity, and relationship of ECD to complications of Descemet’s stripping and automated endothelial keratoplasty (DSAEK) combined with phacoemulsification and intraocular lens (IOL) implantation in patients with coexistent Fuchs’ endothelial dystrophy and immature senile cataracts.
Methods: :
All patients underwent concurrent phacoemulsification with posterior chamber IOL implantation and DSAEK. All cases were performed by a single surgeon (SBK). Paired samples t-test was performed for ECD analysis.
Results: :
A total of 72 eyes of 58 patients were included. Average age at time of surgery was 71.2 years. Mean follow-up was 19 months (range: 6-36 months). Follow-up range varied as follows: 6 months: 64 eyes; 12 months: 63 eyes; 24 months: 28 eyes; 36 months: 6 eyes. Average preoperative best spectacle-corrected visual acuity (BSCVA) was 20/77. At 24 months, average BSCVA was 20/29. Average preoperative pachymetry was 662 microns (range 550-931; SD: 72.8). Average donor ECD was 2790 cells/mm2 (range: 2212-3663; SD: 256).ECD averaged 1787 cells/mm2 at 6 months; this was statistically different from baseline (p<0.0001). ECD averaged 1542 cells/mm2 at 12 months; this was statistically different from baseline (p<0.0001), and 6 months (p=0.03). ECD averaged 1360 cells/mm2 at 24 months; this was statistically different from baseline (p<0.0001), 6 months (p=0.03), and 12 months (p=0.03). ECD averaged 1115 cells/mm2 at 36 months.The percent ECD lost from preoperative baseline was 35.1% at 6 months, 43.7% at 12 months, 50.1% at 24 months, and 58.6% at 36 months. Complications included graft dislocations requiring repositioning (12), acute graft rejection (8), and pupillary block glaucoma (3). At 24 months, the percent ECD from baseline was not statistically different for patients who experienced one or more rejection episodes (p=0.3), for patients who experienced early postoperative pupillary block (p=0.9), or for patients who required repositioning of the lenticule (p=0.08). All grafts remained clear at last postoperative visit.Follow-up is ongoing and will include 58 eyes with 2-year data and 22 eyes with 3-year data at presentation.
Conclusions: :
This longitudinal series of DSAEK combined with phacoemulsification and IOL implantation demonstrates steady attrition of endothelium of the donor lenticule, but all grafts remained clear at last postoperative visit. No association was observed between amount of cell loss and the occurrence of postoperative complications.
Keywords: cornea: endothelium • cell survival • cataract