Combined Phaco and Ultrathin DSAEK in Patients With Fuchs Corneal Endothelial Dystrophy: Long-Term Results
Purpose
To evaluate clinical outcomes of triple procedures including phacoemulsification, IOL implantation and Ultrathin graft DSAEK for Fuchs’ corneal endothelial dystrophy combined with cataract.
Methods
Thirty-one patients (31 eyes) with Fuchs’ corneal dystrophy and cataract were operated. Time of observation 18.4±5.6 months (2 to 37). Preoperatively UCVA, BCVA, IOP funduscopy, optical pachymetry, US and/or optical biometry, confocal microscopy were performed. Donor cornea endothelial cell density was examined at the eye bank. Surgery included phacoemulsification performed followed by foldable IOL implantation. The wound was extended to 4.5 mm and ultrathin endothelial graft prepared with the double- or triple- pass technique with LSK One microkeratome (Moria) was inserted and fixated to the posterior stoma, air bubble was injected into Ac. Interrupted 10/0 nylon sutures were placed. Postoperatively patients were examined at 1 day, 1 week, 1, 2, 6, 12, and 24 months.
Results
Preop UCVA was 0.12+/-0.07, BCVA 0.15+/-0.11, corneal thickness 685±55 μm, EC density 620 ± 180 cells/sq.mm, IOP 14 ± 3,2 mm Hg, donor cornea EC density 2714±130 cells/sq. mm. Early complications: donor cornea perforation (2), graft edge incarceration into the wound (1). Early postop 2 pupillary blocks (cured by burping the air from anterior chamber on the first day) were diagnosed. Late complications included 1 case of transplant rejection and 3 cases of slight graft decentration (~1,0 mm). After the triple procedure, BCVA was 0.45±0.16 at 1 month and 0.67±0.20 at 2 years, refractive SE at 1 month averaged +1.12±1.97 dptr and +0.51±1.73 dptr at 2 years. Postoperative mean ECD was 2512±194 cells/sq.mm at 1 month and 2002±216 cells/sq.mm at 2 years. Final endothelial cell loss 26.3±5.8%.
Conclusion
Triple procedure /Phaco+IOL+UT-DSAEK/ provided rapid visual recovery in patients with Fuch’s corneal endothelial dystrophy associated with cataract. There were no severe or sight-threatening complications, apart from one graft rejection episode. Most of adverse effects were correctable and did not require additional interventions. The accuracy of refractive outcomes was also reasonably good (0.51 +/- 1.73 D).