Comparison of ACIOL Exchange and Descemet Membrane Endothelial Keratoplasty with ACIOL Retention and Descemet Stripping Automated Endothelial Keratoplasty in the Setting of Pseudophakic Bullous Keratopathy

Objective: To compare the clinical outcomes and complications of anterior chamber intraocular lens (ACIOL) exchange and Descemet membrane endothelial keratoplasty (DMEK) with ACIOL retention and Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with PBK.Methods: A multicenter retrospective cohort study. Patients with ACIOL who underwent endothelial keratoplasty procedure due to PBK between 2012-2018 in two tertiary medical centers, were identified. Clinical and demographical data including preoperative and postoperative characteristics were collected.Results: Thirteen eyes in the “DMEK and ACIOL exchange” group and 15 in the “DSAEK and ACIOL retention” group were included in the analysis. Mean BCVA six months postoperatively was 0.51±0.20 LogMAR (Snellen 20/64) and 0.57±0.22 LogMAR (Snellen 20/83) in the “DMEK and ACIOL exchange” group and “DSAEK and ACIOL retention” group, respectively (P=0.38). Graft failure occurred in 6 eyes (40%) in the “DSAEK and ACIOL retention” group; four of them were secondary failures occurring at an average follow-up time of 15±11.9 months. In the “DMEK and ACIOL exchange” group, graft failure occurred in one eye and was a primary failure (P=0.046). In the “DMEK and ACIOL exchange” group, postoperative complications were seen in 4 eyes (30.7%). No postoperative complications were recorded in the “DSAEK and ACIOL retention” group (P=0.035).Conclusion: Despite the lower complication rate, the higher incidence of graft failure and the need for second keratoplasty in the DSAEK group along with the similar visual outcomes, might suggest that in the indication of PBK, ACIOL exchange with DMEK offers a good alternative to ACIOL retention with DSAEK.