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S. Elderkin, A. Djalilian, E. Tu, J. Sugar, S. Reddy, A. Kadakia, R. Ramaswamy, O. Lopez; Outcomes of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in Patients With a Pre-Existing Anterior Chamber Intraocular Lens. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2185.
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In select patients with corneal decompensation and an open loop ACIOL, DSAEK without IOL exchange may be preferred over suturing a new IOL to the sulcus or iris. These include patients with adequate chamber, patients with very advanced age, or patients whose corneal decompensation is predominantly due to the original cataract surgery and not due to the ACIOL specifically. This study was performed to evaluate the outcome of Descemet Stripping Automated Endothelial Keratoplasty (DSEAK) in patients with an anterior chamber intraocular lens (ACIOL).
Retrospective review of 10 patients with an anterior chamber intraocular lens and corneal decompensation who underwent DSAEK. All patients had open loop style ACIOLs with adequate anterior chamber depth. At the time of surgery, the graft was secured using 1-2 temporary sutures in 7 of the patients. The rate of donor detachment, graft size, and donor tissue characteristics as well as pre and post-operative pachymetry, intraocular pressure, and visual acuity at 1, 3, and 6 months were noted.
There were no intraoperative complications. The IOL was not exchanged in any of the patients. Graft sizes ranged from 6.5 - 8.0 mm. There were 2 graft dislocations post-operatively, which were successfully repositioned with an air bubble. Post-operative pachymetry and corneal clarity at 6 months improved in all but one patient. Post-operative visual acuity at 6 months was improved in 8 of the 10 patients.
This series demonstrates that DSAEK may be a viable option in patients with ACIOLs. The rate of graft dislocations was higher than usual (20%) however short term results suggests indicate 90% graft survival at 6 month. Long-term studies including endothelial cell counts will be necessary to determine the safety and efficacy of DSAEK in this patient population.
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