Descemet Stripping with Automated Endothelial Keratoplasty for Bullous Keratopathies Secondary to Argon Laser Iridotomy-Preliminary Results and Usefulness of Double-Glide Donor Insertion Technique

摘要

Purpose: Manipulation of the endothelial donor lamella in the anterior chamber during Descemet stripping with automated endothelial keratoplasty (DSAEK) is often difficult, especially in cases with bullous keratopathies (BK) secondary to argon laser iridotomy (ALI). We developed a novel nonfolding donor insertion technique using a Busin glide and an intraocular lens (IOL) sheet glide and evaluated post-DSAEK outcomes for ALI-induced BK using several insertion techniques.Methods: Fourteen patients (mean age, 74.2 +- 4.9 years) with ALI-induced BK underwent DSAEK; simultaneous cataract surgery was performed in 12 patients. Donor insertions were done by taco-folding (n = 4), spatula-assisted (n = 3), Busin glide-assisted (n = 2), and Busin glide/IOL glide-assisted methods (n = 5). Endothelial cell counts, postoperative visual acuity, induced astigmatism, and complications were examined over a mean follow-up period of 228.3 +-132.2 days (range 58-458 days).Results: In 1 case, DSAEK was converted to penetrating keratoplasty because of difficulties in donor insertion by the taco-folding method, resulting in vitreous prolapse. Overall, mean postoperative endothelial cell count was 1654.2 +- 532.3 cells/mm~2 (range 853-2610 cells/mm~2), a 44.9% reduction compared with donor counts (mean 3003.3 +- 425.5 cells/mm~2). All patients reached acuity >20/40, with 3 (23.1%) reaching 20/20. Mean induced astigmatism in measurable cases was O.53D +- 0.38D. Although nonsignificant due to the small sample size, use of Busin glide with (37.9%) or without IOL glide (37.0%) tended to cause less endothelial damage than tacp-folding (49.0%) or pull-through with spatula (44.2%) at 3 months postoperatively.Conclusions: DSAEK is effective in eyes with ALI-induced BK. Our results suggest that insertion with a Busin glide is reliable and associated with less endothelial cell damage than the conventional taco-folding technique. Simultaneous use of IOL glide (Kobayashidouble-glide method) to help prevent iris prolapse is our preferred insertion method for narrow-angle eyes.