Case Reports

Descemet's stripping automated endothelial keratoplasty (DSAEK) for pseudophakic bullous keratopathy with multifocal IOL in situ

Case Report Details

First Author: I.Lal INDIA

Co Author(s):    P. K                    

Abstract Details

Purpose:

To evaluate the visual and refractive outcome of Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) in a case of pseudophakic corneal decompensation after multifocal intra-ocular lens implantation.

Setting:

Delhi Eye Centre, 3/24, Old Rajinder Nagar, New Delhi- 110060 India

Report of Case:

This is a case report of a 67 years old male patient who presented to us with complaints of diminution of vision in the right eye one and a half years post cataract surgery. Clinical examination on slit lamp revealed inferior corneal edema and a well centred multifocal intra-ocular lens (IOL) in the bag. Central corneal thickness of 667 microns was noted on Optical Coherence Tomograhy (OCT) and specular count was unrecordable. The patient was diagnosed with pseudophakic bullous keratopathy (PBK) and was hence planned to undergo DSAEK surgery without exchange or explantation of the existing multifocal IOL. A small nuclear fragment was retrieved from the angle during the surgery which was removed from the anterior chamber. Persistent inflammation caused by the nuclear fragment was proposed to be the cause of PBK in this case. A 8 mm lenticule was transplanted during the procedure which was well apposed on first post-operative day. At 3 months and 6 months follow-up, the uncorrected distance visual acuity (UDVA) was found to be 20/30 which was same as the best corrected distance visual acuity (BCDVA). The uncorrected near visual acuity was N6. At 8 months post-operatively, the patient developed inferior corneal edmea and a small nuclear fragment was noted in the anterior chamber. This lens fragment was subsequently removed and the patient regained UCDVA of 20/30 one week later. at 1 year follow up, the postoperative refractive error was found to be +0.20DS/-0.53DCx104 ° with high order aberrations of 86.1% in the right eye which was higher in comparison to the left (45.5%). The contrast sensitivity however was not affected with 0.1 log units in both eyes. At the last follow up (2 years), UCDVA 20/30 with a near vision of N6 was maintained with no significant refractive error.

Conclusion/Take Home Message:

Bullous keratopathy in patients with multifocal IOL can be safely managed with DSAEK yielding good visual outcome and fast visual recovery. The visual acuity and refraction remained stable at 2 years after the procedure

Financial Disclosure:

None