Analysis Of Refractive Outcome And Complications Of Descemet's Stripping And Automated Endothelial Keratoplasty (DSAEK) With Scleral-fixated Sutured Posterior Chamber Intraocular Lens

摘要

Purpose: : To evaluate refractive outcome and complications of Descemeta??s stripping and automated endothelial keratoplasty (DSAEK) combined with scleral-fixated sutured posterior chamber intraocular lens in patients with coexisting endothelial decompensation and absence of posterior lens capsular support. Methods: : A standardized technique of DSAEK via a 5.2 mm scleral tunnel incision with forceps insertion was performed with suture fixation of intraocular lens (IOL) transclerally in the posterior chamber. This surgery was jointly performed by two surgeons; one performed the DSAEK, while the other placed the scleral-fixated intraocular lens. Explantation of an anterior chamber intraocular lens (ACIOL) was conducted if present. Visual acuity (VA), intraocular pressure (IOP), and refractive parameters were analyzed in patients both prior and following the procedure. Results: : Five eyes of five patients underwent combined DSAEK with scleral-fixated sutured posterior chamber intraocular lens. Mean age was 78.4 (range 61-94). Cases of pseudophakic bullous keratopathy, failed DSAEK graft, Fuchs corneal dystrophy were included. Four patients underwent ACIOL explantation, while one was aphakic at the time of surgery. Target IOL calculation was -0.50 sphere. Mean followup was 9.2 months (range 2-21 months). Preoperative visual acuity ranged from 20/200 to hand motion. The uncorrected and best-corrected visual acuity (BCVA) improved in all cases, (range 20/40 to 20/200.) Irregular astigmatism affected the refractive result. IOP ranged from 10-26 in all patients. There was no evidence of donor dislocation, iatrogenic primary graft failure or cystoid macular edema in all cases. Conclusions: : This small pilot series suggests a visual benefit in cases of concurrent DSAEK with scleral-fixated sutured posterior chamber intraocular lens in patients lacking posterior lens capsular support, including aphakic patients and those with ACIOL. No complications of graft dislocation, iatrogenic primary graft failure, or cystoid macular edema occurred. There is a potential benefit of improved endothelial cell survival from ACIOL explantation in preventing lens-cornea touch. In aphakic patients, scleral-fixated sutured posterior chamber intraocular lens may decrease risk of graft dislocation from loss of air bubble tamponade. Larger prospective, comparative studies are warranted to confirm these initial findings.