Complications and clinical outcomes of descemet stripping automated endothelial keratoplasty with intraocular lens exchange

Am J Ophthalmol. 2010 Mar;149(3):390-7.e1. doi: 10.1016/j.ajo.2009.11.002.


Purpose: To evaluate complications and clinical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with intraocular lens (IOL) exchange compared with DSAEK alone.

Design: Retrospective, interventional case series.

Methods: DSAEK was performed in 19 eyes in which the anterior chamber IOL was exchanged for a posterior chamber IOL (study group) and in 188 eyes in which the posterior chamber IOL was left in place (comparison group). The complications of graft dislocations, primary graft failure episodes, and pupillary block were recorded for all eyes. Six-month best spectacle-corrected visual acuity and mean central endothelial cell density were measured prospectively and then compared with preoperative values for all eyes.

Results: Dislocations occurred in 0 (0%) of 19 eyes in the study group and in 5 (3%) of 188 eyes in the comparison group (P = .47), with 0 primary graft failures and 0 pupillary block episodes in either group. Preoperative mean best spectacle-corrected visual acuity for those eyes without any underlying ocular comorbidities was 20/205 and 20/100 in the study and comparison groups, respectively (P = .18). Mean best spectacle-corrected visual acuity at 6 months improved to 20/48 in the study group and to 20/34 in the comparison group, a statistically significant difference (P = .01). Mean donor cell loss at 6 months was 33% in the study group and 26% in the comparison group (P = .18).

Conclusions: Concurrent IOL exchange with DSAEK surgery does not increase the dislocation, primary graft failure, or pupillary block rates in the immediate postoperative period. Donor endothelial cell loss in DSAEK was not increased significantly by IOL exchange. Visual acuity was slightly worse after combined surgery than after DSAEK alone.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cell Survival
  • Descemet Stripping Endothelial Keratoplasty / adverse effects*
  • Endothelium, Corneal / pathology
  • Female
  • Graft Survival
  • Humans
  • Intraoperative Complications*
  • Lens Implantation, Intraocular*
  • Lenses, Intraocular
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Prospective Studies
  • Retrospective Studies
  • Treatment Outcome
  • Visual Acuity / physiology