Influence of Early Descemet Stripping Endothelial Keratoplasty on Visual Outcomes in Pseudophakic Corneal Edema

Factors Predictive of Double Anterior Chamber Formation Following Deep Anterior Lamellar Keratoplasty

PURPOSE

To identify risk factors predictive of postoperative double anterior chamber formation after deep anterior lamellar keratoplasty (DALK).

DESIGN

Retrospective institutional cohort study.

METHODS

The study group included all consecutive eyes undergoing primary DALK between May 2015 and October 2018 at Villa Igea private hospital (Forli, Italy). The indications for surgery were categorized as (1) keratoconus without scarring; (2) keratoconus with scarring; (3) non-keratoconus without scarring; and (4) non-keratoconus with scarring. Multivariate binary logistic regression analysis was performed, introducing, as independent variables, those that reached a significance level of less than .05 in univariate analysis. The main outcome measure was whether or not postoperative double anterior chamber (AC) occurred.

RESULTS

A total of 591 eyes of 591 patients were included. The main indication for DALK was keratoconus (67.2%, n = 397), and pneumatic dissection was achieved in 72.9% (n = 431) of patients. Postoperative double AC was observed in 8.1% (n = 48) of cases. Age, intraoperative central DM perforation, type 2 bubble formation, and presence of scar in keratoconic and nonkeratoconic corneas were all associated with an increased risk of postoperative double AC formation in the univariate analysis. Manual dissection was not associated with double AC formation. The factors that remained significant in multivariate analysis were keratoconus with scarring (odds ratio [OR] = 3.56, P = .02), non-keratoconus with scarring (OR = 5.09, P = .002), intraoperative central perforation (OR = 6.09, P = .03), and type 2 bubble formation (OR = 14.17, P < .001).

CONCLUSIONS

Scarred corneas of both normal and abnormal shape are independent risk factors for double AC formation following DALK, along with intraoperative perforation and the occurrence of a type 2 bubble.

Different graft thicknesses after Descemet stripping endothelial keratoplasty for bullous keratopathy in the two eyes of the same patient

Objective

To describe a very unique case of two Descemet stripping automated endothelial keratoplasty (DSAEK) surgeries performed in both eyes of the same patient with an extremely different graft thickness and overall corneal thickness but with the same corrected distance visual acuity (CDVA) 2 years after surgery.

Case presentation

A 75-year-old woman with bilateral bullous keratopathy (BK) was submitted to DSAEK surgeries in both eyes, first in right and after 6 months in left eye. CDVA was 20/160 in the right eye and 20/63 in the left eye. Corneal thickness evaluated by anterior segment optical coherence tomography was 569 µm in the right eye and 560 µm in the left eye. The root mean square (RMS) was 2.1 in the right and left eyes. Endothelial cell densities were not detectable in both eyes. The estimated precut donor graft thickness from eye bank was 250 and 40 µm in the right and in the left graft, respectively. Two years after surgery CDVA was 20/25 in both eyes. Corneal thickness was 633 µm with a lenticule thickness of 206 µm in the right eye and 439 µm with a lenticule thickness of 48 µm in the left eye. The RMS was 1.7 in the right eye and 1.4 in the left eye. Endothelial cell density was 2.272 cells/mm² in the right and 2.154 cells/mm² in the left eye.

Conclusion

DSAEK was safe and effective in the treatment of BK. In our report, the visual outcome resulted to be poorly related either to donor graft thickness or to postoperative corneal thickness.

Long-term Visual Outcomes Comparing Descemet Stripping Automated Endothelial Keratoplasty and Penetrating Keratoplasty

PURPOSE

To compare 5-year visual acuity and refraction outcome in Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) for Fuchs endothelial dystrophy (FED) or bullous keratopathy (BK) in Asian eyes.

DESIGN

Prospective interventional case series.

METHODS

We analyzed 828 consecutive cases of DSAEK (423) or PK (405) for FED and BK from the Singapore Cornea Transplant Registry performed from 1991 to 2011. Our main outcome measures were best spectacle-corrected visual acuity (BSCVA) with astigmatism (cylinder) and spherical equivalent (SE) over 5 years of follow-up.

RESULTS

Mean age was 67.5 ± 11.5 years (50.1% male, 49.9% female) and majority was Chinese (76.6%, n = 634) in our multiracial Asian population. DSAEK eyes had significantly better BSCVA (P < .001-.037) with lower SE (P < .001-.017) and cylinder (P < .001), independent of surgical indication, compared to PK over 5 years. DSAEK was superior to PK over 5 years (P < .001-.026) in FED, but only over 3 years in BK (P < .001-.031). DSAEK in FED eyes had significantly better BSCVA compared to BK eyes (P = .006 at 4-year follow-up). DSAEKs with preoperative BSCVA < 1.3 logMAR had significantly better visual outcomes than cases with ≥ 1.3 logMAR (P < .001-.042). PKs had significantly higher postoperative refractive correction than DSAEKs, with no significant influence of the surgery indication.

CONCLUSIONS

In our study cohort, DSAEK provided significantly better long-term BSCVA and lower astigmatism than PK over 5 years of follow-up. Visual outcomes of DSAEK for FED were better than BK. In some analyses for years 1-3, analysis of covariance adjustment indicated that this DSAEK-associated better long-term BSCVA was independent of better preoperative vision in DSAEK eyes.