New Triple Procedure: Descemet’s Stripping and Automated Endothelial Keratoplasty Combined with Phacoemulsification and Intraocular Lens Implantation
Received 10 August 2006; accepted 20 December 2006. published online 13 April 2007.
Purpose
To evaluate visual acuity (VA), graft clarity, and refractive outcome of Descemet’s stripping and automated endothelial keratoplasty (DSAEK) combined with phacoemulsification and intraocular lens (IOL) implantation in patients with coexisting Fuchs’ endothelial dystrophy and immature senile cataracts.
Design
Pilot, prospective, noncomparative, surgical case series.
Participants
Twenty-one eyes of 21 consecutive patients with coexisting visually significant immature senile cataracts and Fuchs’ corneal dystrophy with guttata of Descemet’s membrane and either microcystic epithelial edema or stromal edema presenting to a single academic eye institute.
Methods
All patients underwent phacoemulsification and posterior chamber IOL implantation through temporal clear corneal incision, followed by DSAEK. The intent was to render all eyes as close to emmetropia as possible.
Main Outcome Measures
Six-month postoperative best spectacle-corrected VA (BSCVA), refractive spherical equivalent (SE), refractive astigmatism, and keratometry.
Results
Average BSCVAs were 20/68 preoperatively and 20/34 postoperatively (P<0.0001). The postoperative SE refractive error was +0.45 diopters (D), on average +1.13 D more hyperopic than predicted by preoperative lens power calculations. Overall, 13 patients (62%) were within 1.00 D and 21 (100%) were within 2.00 D of emmetropia postoperatively. Preoperative and postoperative average refractive astigmatisms were 1.46 D and 1.56 D, respectively (P = 0.69). Complications included graft dislocations requiring repositioning (3), 2 of which experienced recurrent dislocation requiring reoperation with a new graft; acute graft rejection (3); and pupillary block glaucoma (2).
Conclusions
This pilot case series of 6-month results of DSAEK combined with phacoemulsification and IOL implantation suggests that it provides rapid visual rehabilitation with predictable refractive outcomes.
Eye Institute, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin.
Correspondence to Steven B. Koenig, 925 North 87th Street, Milwaukee, WI 53226.
Manuscript no. 2006-899.
Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York.
ABSTRACT