Descemet-Stripping Automated Endothelial Keratoplasty With Anterior Chamber IOLs: Complications and 3-Year Outcomes

Lim, Li

Descemet-Stripping Automated Endothelial Keratoplasty With Anterior Chamber IOLs: Complications and 3-Year Outcomes

Friday, April 25, 2014

KIOSKS (Boston Convention and Exhibition Center)

Li Lim, FRCS(Ed), MMed (Ophth), Singapore National Eye Centre, Singapore, Singapore

Marcus Ang, MBBS, MMed, Singapore National Eye Centre, Singapore, Singapore

Donald TH Tan, FRCS, Singapore National Eye Center, Singapore, Singapore

Jod S. Mehta, MD, FRCSEd, Singapore National Eye Centre, Singapore, Singapore

Narrative Responses:

Purpose
To describe outcomes and complications following Descemet’s stripping automated endothelial keratoplasty (DSAEK) in eyes with pseudophakic bullous keratopathy (BK) while retaining the anterior chamber intraocular lenses (ACIOL).

Methods
Cohort study of consecutive patients who underwent DSAEK for BK at a single tertiary center from 1st January 2008 to 1^st April 2010. Clinical data, donor and recipient characteristics were reviewed from our prospective cohort from the Singapore Corneal Transplant Study. We compared eyes with BK, which underwent DSAEK while retaining ACIOL, to those with DSAEK alone with the posterior chamber intraocular lenses (PCIOL) left in place as a comparison group.

Results
Mean age of our study cohort was 69±10 years and 50.8% were male. A significantly higher proportion of eyes with DSAEK/ACIOL developed de-novo glaucoma (44.4% versus 17.5%, P=0.009) within 1 year. The percent EC loss at 1 year was 31.9±21.3 in the DSAEK with ACIOL group compared to DSAEK group (24.5±21.2, P = 0.223); and significantly more in DSAEK with ACIOL at 3 years compared to DSAEK (DSAEK with ACIOL: 55.3±29.2 versus DSAEK: 33.3±20.8; P=0.01). Graft survival was significantly poorer in the DSAEK ACIOL group compared to the DSAEK group (log-rank P=0.002).

Conclusion
We found that eyes with BK and ACIOL that underwent DSAEK while retaining the ACIOL suffered a significantly higher incidence of glaucoma; and endothelial cell loss and graft survival were significantly poorer compared to DSAEK controls at 3 year follow-up.