Glued intraocular lens with descemet stripping endothelial keratoplasty in aphakic bullous keratopathy

Introduction. Sutureless transplantation of endothelium on a thin stromal carrier was introduced under the name of Descemet stripping endothelial keratoplasty (DSEK) in 2004. It has become the treatment of choice of corneal oedema due to endothelial dysfunction. Objective. To investigate posterior lamellar graft attachment, central corneal thickness (CCT), astigmatism, and best corrected visual acuity (BCVA) during one-year follow-up. Methods. Surgery was performed on one eye of 11 patients with pseudophakic bullous keratopathy and Fuchs? dystrophy. The graft thick 150-200 ?m and 8.0 mm in diameter was detached manually. The carrier of the recipient cornea was created by DSEK. The graft was folded in half, introduced into the anterior orbital chamber through a 5.0 mm cut on the limbus and attached by air bubble along the internal side of the recipient cornea. CCT and astigmatism were evaluated by corneal topography, and graft attachment by biomicroscopy. Results. One year after surgery, all grafts remained attached. Primary graft failure occurred in three eyes, probably due to the crushing effect of the forceps. BCVA was 20/30 (2 eyes), and 20/40 (6 eyes), CCT 643-728 ?m, and astigmatism 1.1 D to 2.9 D. The peak values were reached three months after surgery, and did not change much afterwards. Conclusion. This is the first report on the long-term results of DSEK in our literature. The results are similar to those obtained by more experienced DSEK surgeons, and suggest that this procedure is safe and successful.

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Clinical Outcomes of Combined Descemet-stripping Endothelial Keratoplasty and Intraocular Lens Exchange

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2016.57.9.1361 ◽

2016 ◽

Vol 57 (9) ◽

pp. 1361 ◽

Cited By ~ 1

Author(s):

Dong Jin Kang ◽

Hong Kyun Kim

Keyword(s):

Clinical Outcomes ◽

Intraocular Lens ◽

Endothelial Keratoplasty ◽

Descemet Stripping Endothelial Keratoplasty ◽

Intraocular Lens Exchange

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Endothelial keratoplasty with anterior chamber intraocular lens versus secondary posterior chamber intraocular lens

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316711 ◽

2020 ◽

pp. bjophthalmol-2020-316711

Author(s):

Jyh Haur Woo ◽

Anshu Arundhati ◽

Soon-Phaik Chee ◽

Weihan Tong ◽

Lim Li ◽

...

Keyword(s):

Anterior Chamber ◽

Graft Survival ◽

Intraocular Lens ◽

Posterior Chamber ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Significant Difference ◽

Iris Claw ◽

Iol Exchange

AimTo describe the long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with an anterior chamber intraocular lens (ACIOL) compared to secondary posterior chamber (PC) IOL.MethodsThis was a retrospective comparative cohort study. The clinical data of 82 eyes from 82 consecutive patients with pseudophakic (PBK) or aphakic bullous keratopathy (ABK) who either underwent DSAEK with retained or secondary ACIOL (n=23) or DSAEK with IOL exchange and/or secondary PCIOL (retropupillary iris-claw IOL, n=25; intrascleral-fixated IOL, n=29; or sulcus IOL, n=5) were analysed. The main outcome measures were graft survival and complications up to 5 years.ResultsThe graft survival in the secondary PCIOL group was superior than the ACIOL group over 5 years (year 1, 100.0% vs 100.0%; year 3, 94.7% vs 75.0%; year 5, 91.1% vs 60.6%, p=0.022). The presence of an ACIOL was a significant risk factor associated with graft failure (HR, 4.801; 95% CI, 1.406 to 16.396, p=0.012) compared to a secondary PCIOL. There was no significant difference in the rate of graft detachment and elevated intraocular pressure between the groups. There were five cases (9.3%) of IOL subluxation or dislocation in the retropupillary iris-claw and intrascleral-fixated IOL groups.ConclusionsEyes that underwent DSAEK with ACIOL in situ had poorer long-term graft survival compared with those with secondary PCIOL. Intraocular lens exchange was not associated with a higher complication rate. In ABK or PBK eyes with ACIOL, we recommend performing IOL exchange and/or secondary PCIOL implantation combined with endothelial keratoplasty.

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Management of Angle-supported Intraocular Lens and Iridectomy in Descemet-Stripping Endothelial Keratoplasty

Cornea ◽

10.1097/ico.0b013e31815b8967 ◽

2008 ◽

Vol 27 (2) ◽

pp. 223-224 ◽

Cited By ~ 10

Author(s):

Damian B Lake ◽

Chad K Rostron

Keyword(s):

Intraocular Lens ◽

Endothelial Keratoplasty ◽

Descemet Stripping Endothelial Keratoplasty

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Visual Outcome of Combined Descemet Stripping Endothelial Keratoplasty and Sutured Scleral Fixated Intraocular Lens in Endothelial Decompensation with Coexistent Aphakia or Intra Ocular Lens Subluxation

Annals of the National Academy of Medical Sciences (India) ◽

10.1055/s-0041-1739036 ◽

2021 ◽

Author(s):

Jaya Kaushik ◽

Ankita Singh ◽

Rakesh Shetty ◽

Jitendra Kumar Singh Parihar ◽

Divya Kochhar ◽

...

Keyword(s):

Visual Acuity ◽

Visual Outcome ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Ocular Lens ◽

Descemet Stripping Endothelial Keratoplasty ◽

Lens Subluxation ◽

Preoperative Visual Acuity ◽

Endothelial Decompensation

Abstract Purpose To elucidate visual outcome of patients after combined Descemet stripping endothelial keratoplasty (DSEK) with scleral fixated intra ocular lens (SFIOL) implantation in patients of endothelial decompensation with coexistent aphakia or lens subluxation. Materials and Methods A prospective interventional study of combined DSEK with sutured SFIOL in the patients who have undergone surgery at our center over 6-month follow-up period. Preoperative visual acuity and slit lamp findings were documented. Postoperative follow-up was done at days 1, 3, and 7 subsequently, months 1 and 3, and thereafter monthly till the sixth month. Results Mean age of the patients was 60.47 years. Six patients had aphakic bullous keratopathy, while 11 patients had pseudophakic bullous keratopathy with subluxated posterior chamber IOL (PCIOL). Preoperative visual acuity ranged from hand movements close to face (LogMar 2.4) with accurate projection of rays to 1/60 (LogMar 2) due to existing corneal edema and aphakia. Postoperatively uncorrected visual acuity at 6 months improved up to 6/36 (LogMar 0.8) in all cases. There was gradual improvement in corneal clarity and compactness during the follow-up. A good donor tissue endothelial count and an adequate IOP control were vital prognostic factors for the successful outcome. Conclusion This novel surgical merger reduces the complications of lenticule dislocation into vitreous and repeated surgeries and shows results akin to when performed in a staged manner.

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