Early outcomes of descemet stripping automated endothelial keratoplasty in pseudophakic eyes with anterior chamber intraocular lenses.

PURPOSE: To evaluate complications and clinical outcomes of Descemet stripping automated endothelial keratoplasty in eyes with preexisting anterior chamber intraocular lenses. DESIGN: Retrospective review. METHODS: Thirty-one patients who underwent Descemet stripping automated endothelial keratoplasty and who had a preexisting anterior chamber intraocular lens were identified from May 2006 through March 2009. Patient follow-up ranged from a minimum of 1 month up to 30 months. Preoperative and postoperative best spectacle-corrected visual acuity, manifest refraction, comorbid conditions, and complications were recorded. Endothelial cell loss, graft dislocation, graft failure rates were calculated. RESULTS: The mean age at surgery was 78 ± 9 years (range, 53 to 91 years). All eyes had pseudophakic bullous keratopathy, except 1 patient who had a failed penetrating keratoplasty graft. Excluding those patients with severely limited visual potential because of noncorneal pathologic features, the mean best spectacle-corrected visual acuity improved significantly from 20/200 to 20/400 before surgery to 20/63 at 3 months (P < .0001), 20/60 at 6 months (P = .0006), 20/50 at 12 to 15 months (n = 10; P = .004), and 20/40 between 23 and 30 months (n = 8; median, 25 months; P = .007). The preoperative mean spherical equivalent was -0.3 ± 1.8 diopters compared with -0.15 ± 1.5 diopters after surgery (P = .78). The graft dislocation rate was 13%, and the graft failure rate was 16%. For those patients with endothelial cell density data available, the average endothelial cell loss was 48% at a mean of 14 months. CONCLUSIONS: Although Descemet stripping automated endothelial keratoplasty surgery in patients with an anterior chamber intraocular lens remains a controversial topic, the visual and anatomic outcomes from this limited study support this approach as a surgical option in selected cases.

Duke Scholars

Author Terry Kim Ophthalmology, Corneal Diseases

Author Anna Hong Bordelon Ophthalmology, Comprehensive Ophthalmology