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Gu S, Peng R, Xiao G, Hong J. Severe Corneal Edema Increases ECL From Grafts After DSAEK-Corneal Edema and ECL After DSAEK. Eye Contact Lens 2022; 48:250-255. [PMID: 34739409 PMCID: PMC9119398 DOI: 10.1097/icl.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the relationship between the preoperative degree of corneal edema in the recipient and the endothelial cell density in grafts after Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS This retrospective case series enrolled 111 eyes of 107 patients who underwent DSAEK. The preoperative and postoperative central corneal thickness (CCT) was measured by anterior-segment optical coherence tomography. Eyes were divided into three groups according to the preoperative recipient CCT: group A (mild edema): 550 μm RESULTS The recipient CCT (all groups combined) was 805.99±132.70 μm preoperatively and decreased to 656.31±105.02 μm at 1 month, decreased to 626.08±81.40 μm at 6 months, and remained stable between 12 (P=0.144) and 24 months (P=0.485) postoperatively. The mean ECL was 27.34±15.43%, 33.56±17.13%, 39.18±16.71%, and 45.87±14.27% at 1, 6, 12, and 24 months, respectively. The percentage of ECL in group C was higher than that in the other 2 groups through the 24-month follow-up. The difference in ECL between groups A and C was significant at 24 months (group A: 42.45±14.47%; group C: 52.49±10.65%; P=0.019). CONCLUSIONS The degree of corneal edema in the recipient was associated with implant ECL. Compared with mild and moderate corneal edema, the severe corneal edema may cause greater ECL after DSAEK.
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Affiliation(s)
- Shaofeng Gu
- Department of Ophthalmology (S.G., R.P., G.X., J.H.), Peking University Third Hospital, Beijing, China; and Beijing Key Laboratory of Restoration of Damaged Ocular Nerve (S.G., R.P., G.X., J.H.), Peking University Third Hospital, Beijing, China.
| | - Rongmei Peng
- Department of Ophthalmology (S.G., R.P., G.X., J.H.), Peking University Third Hospital, Beijing, China; and Beijing Key Laboratory of Restoration of Damaged Ocular Nerve (S.G., R.P., G.X., J.H.), Peking University Third Hospital, Beijing, China.
| | - Gege Xiao
- Department of Ophthalmology (S.G., R.P., G.X., J.H.), Peking University Third Hospital, Beijing, China; and Beijing Key Laboratory of Restoration of Damaged Ocular Nerve (S.G., R.P., G.X., J.H.), Peking University Third Hospital, Beijing, China.
| | - Jing Hong
- Department of Ophthalmology (S.G., R.P., G.X., J.H.), Peking University Third Hospital, Beijing, China; and Beijing Key Laboratory of Restoration of Damaged Ocular Nerve (S.G., R.P., G.X., J.H.), Peking University Third Hospital, Beijing, China.
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Woo JH, Arundhati A, Chee SP, Tong W, Li L, Ti SE, Htoon HM, Choo JQH, Tan D, Mehta JS. Endothelial keratoplasty with anterior chamber intraocular lens versus secondary posterior chamber intraocular lens. Br J Ophthalmol 2020; 106:203-210. [PMID: 33115769 DOI: 10.1136/bjophthalmol-2020-316711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/19/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022]
Abstract
AIM To 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. METHODS This 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. RESULTS The 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. CONCLUSIONS Eyes 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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Affiliation(s)
- Jyh Haur Woo
- Singapore National Eye Centre, Singapore .,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore.,Singapore Eye Research Institute, Singapore
| | - Anshu Arundhati
- Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore.,Singapore Eye Research Institute, Singapore
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore.,Singapore Eye Research Institute, Singapore
| | | | - Lim Li
- Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore.,Singapore Eye Research Institute, Singapore
| | - Seng-Ei Ti
- Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore.,Singapore Eye Research Institute, Singapore
| | - Hla M Htoon
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore.,Singapore Eye Research Institute, Singapore
| | | | - Donald Tan
- Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore.,Singapore Eye Research Institute, Singapore
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore.,Singapore Eye Research Institute, Singapore
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