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Endothelial keratoplasty for bullous keratopathy in eyes with an anterior chamber intraocular lens

Session Details

Session Title: Cornea surgical I

Session Date/Time: Tuesday 08/10/2013 | 08:00-10:30

Paper Time: 08:30

Venue: Forum (Ground Floor)

First Author: : V.Liarakos GREECE

Co Author(s): :    L. Ham   I. Dapena   G. Melles        

Abstract Details

Purpose:

To describe how to approach eyes with phakic or pseudophakic bullous keratopathy while carrying an anterior chamber intraocular lens (AC-IOL), by ‘Thin Descemet stripping endothelial keratoplasty’ (Thin-DSEK) or ‘Descemet membrane endothelial keratoplasty’ (DMEK), with or without AC-IOL removal.

Setting:

Netherlands Institute for Innovative Ocular Surgery

Methods:

Fourteen DMEK and 7 Thin-DSEK surgeries were performed in 11 pseudophakic eyes carrying an iris-claw AC-IOL (Group I; mean age 81±6 years), and 10 phakic eyes presenting with an angle-supported AC-IOL (Group II; mean age 49±9 years). Preoperative surgical considerations were documented, as well as postoperative best corrected visual acuity (BCVA), endothelial cell density, and complications.

Results:

In both groups, DMEK was routinely performed, except in eyes with insufficient corneal transparency or high risk of graft detachment. In Group I, the AC-IOL was left in situ in all cases. In Group II, the angle-supported AC-IOL was removed in 90% of cases. At 6 months, a BCVA ?20/40 (?0.5) was reached by 36% of eyes in Group I and 90% in Group II. Graft detachment occurred in 24%, and de-novo or exacerbation of pre-existing glaucoma in 24%.

Conclusions:

DMEK may be a feasible procedure for routine treatment of bullous keratopathy in eyes with an AC-IOL. Thin-DSEK may be preferred in eyes with low visual potential and/or complicated pathology. AC-IOL may be removed if postoperative complications are anticipated (but not required to facilitate the surgery itself). Overall, the surgical approach may aim to minimize postoperative complications, rather than maximizing visual outcome.

Financial Interest:

NONE