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J. Y. Tsui, M. Wagoner; Visual Outcomes in Phakic Patients Undergoing Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK). Invest. Ophthalmol. Vis. Sci. 2010;51(13):756.
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© ARVO (1962-2015); The Authors (2016-present)
To describe visual outcomes of phakic patients with corneal edema who underwent Descemet’s stripping automated endothelial keratoplasty (DSAEK).
This is a retrospective, observational case series. IRB approval was obtained. Twelve eyes of 12 patients with corneal edema and no visually significant cataracts that underwent DSEAK alone were studied. The charts of all patients who underwent a DSAEK procedure from 2004 to 2007 at the University of Iowa Hospitals and Clinics were reviewed. Baseline characteristics, surgical details and post-operative indices of visual function were entered into a collective database. Patients were excluded if they had traumatic or unusual causes for corneal edema or severe prior sight-altering complications. The main outcome variables were: lens status, complications, best spectacle corrected visual acuity (BSCVA), spherical equivalent (SE), central corneal thickness (CCT), endothelial cell density (ECD), and graft survival.
All 12 patients had corneal edema related to Fuchs corneal endothelial dystrophy. Four patients experienced pupillary block and 1 a had lenticule dislocation requiring rebubbling twice. One patient had an episode of graft rejection that was successfully reversed with topical steroids, and 1 patient experienced graft failure several months after cataract extraction (CE). The BSCVA initially improved in all patients following DSAEK, but 9 of 12 (75%) patients saw progression of their cataracts within an average of 7.6 +/- 7.9 months, and 6 of 12 (50%) eventually required cataract extraction 15.8 +/- 8.3 months after DSAEK. The 6 patients who are still phakic gained a mean of 1.5 Snellen lines compared to a mean of 2 lines gained by the now pseudophakic patients. Patients who underwent CE after DSAEK had a mean myopic shift (1.0 +/- 0.53D), and those receiving only DSAEK had a hyperopic shift (mean of 1.85 +/- 0.93D) in all cases. CCT (mean of 660 microns) and ECD loss (40% in DSAEK only vs. 50% in CE-after patients) did not differ signficantly between groups except in the 1 patient who experienced graft failure after CE.
To our knowledge, this is the only case series of its kind. Most of the patients in this study had progression of cataracts within 8 months, and half eventually required cataract extraction within 16 months. A substantial proportion of patients (33%) had post-operative pupillary block. Lenticule dislocation, post-CE endothelial rejection, and graft failure were also observed in this case series. Phakic DSAEK may be a riskier procedure than staged CE before DSAEK or simultaneous DSAEK and CE.
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