Management and outcomes of descemet stripping automated endothelial keratoplasty with intraocular lens exchange, aphakia, and anterior chamber intraocular lens

Cornea. 2013 May;32(5):e64-8. doi: 10.1097/ICO.0b013e31826ef43b.


Purpose: To compare outcomes and complications of Descemet stripping automated endothelial keratoplasty (DSAEK) in complicated cases with intraocular lens (IOL) exchange, aphakia, or anterior chamber intraocular lens (ACIOL) implants with a group of noncomplicated DSAEK cases.

Methods: Of the 30 complicated DSAEK cases, 14 eyes underwent concurrent IOL exchange, 5 ACIOLs were not removed, 5 eyes remained aphakic, and 5 eyes had IOL exchange done before or after DSAEK. One eye had an iris-supported phakic IOL removed, followed by cataract extraction with IOL implantation at the time of DSAEK. The comparison group included 109 consecutive DSAEK cases with a history of Fuchs dystrophy or pseudophakic bullous keratopathy.

Results: In the complicated group with significant ocular comorbidities, 27.6% achieved best-corrected visual acuity (BCVA) ≥20/40 and 60% had a final BCVA ≥20/70. In the comparison group of patients without visually significant comorbidities, 94.4% of eyes achieved BCVA ≥20/40 with no complication of graft detachments. Of the 30 complicated eyes, 5 (16.7%) had graft detachments and 5 (16.7%) developed IOL dislocations. All grafts remained clear at the last follow-up visit, except 3 cases (10%) in the complicated group, 2 of which were because of primary graft failure and required penetrating keratoplasty.

Conclusions: In comparison with uncomplicated DSAEK cases, higher graft and IOL dislocations were observed in cases involving IOL exchanges, ACIOLs, or aphakia.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anterior Chamber / surgery
  • Aphakia, Postcataract / surgery*
  • Artificial Lens Implant Migration / etiology
  • Artificial Lens Implant Migration / surgery*
  • Descemet Stripping Endothelial Keratoplasty / adverse effects*
  • Device Removal*
  • Female
  • Glaucoma / etiology*
  • Graft Rejection / etiology
  • Humans
  • Lens Implantation, Intraocular*
  • Lenses, Intraocular*
  • Male
  • Middle Aged
  • Reoperation
  • Retrospective Studies
  • Treatment Outcome
  • Visual Acuity / physiology