Early acute pupillary block after Descemet’s stripping endothelial keratoplasty

Session Details

Session Title: Cornea Surgical I

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 09:08

Venue: Boulevard B

First Author: : B.Lorente SPAIN

Co Author(s): :    M. Canut   A. Buigues   J. Alvarez de Toledo        

Abstract Details

Purpose:

To present the risk factors, characteristics and outcome of early acute pupillary block after Descemet’s Stripping Endothelial Keratoplasty (DSAEK).

Setting:

Centro de Oftalmología Barraquer, Barcelona, Spain.

Methods:

Retrospective case series review. The medical records of consecutive DSAEK procedures performed by two experienced surgeons between 2008 and 2013 were reviewed. Cases complicated with early pupillary block after DSAEK were identified and the following data were collected: age, sex, preoperative corrected distance visual acuity (CDVA), associated procedures, perioperative medical treatment, interval between surgery and pupillary block presentation, intraocular pressure (IOP), medical and surgical management, postoperative CDVA, final IOP and graft viability (status).

Results:

174 cases of DSAEK were reviewed, 4 of which suffered early pupillary block after DSAEK (2 males and 2 females, ages between 60 and 80 years old). 2 of the patients underwent DSAEK while the other 2 had a modified triple procedure performed. Perioperative medical treatment included dexamethasone and tobramicine 4 times a day, cycloplegic two times after the surgery and antioedema drops 3 times a day. Interval between surgery and pupillary block presentation was between 8 and 30 hours after surgery. IOP reached between 36-52mmHg. All our patients underwent immediate surgical treatment for liberation of synechia and break the pupillary block. One patient underwent a penetrant keratoplasty only one month after the DSAEK because of a primary graft failure. Another patient, despite the success of the surgical treatment and the graft survival (1655 endothelial cells and BCVA 0.7 3 years after DSAEK), required medical glaucoma treatment in monotherapy. The other two patients had similar results in terms of endothelial cell lost (895 and 1105 cells remaining) and visual acuity (BCVA 0.55 and 0.6) four years after the surgery.

Conclusions:

Even with an energetic and prompt actuation for the management of the pupillary block, the grafts have the possibility of failure due to a very fast formation of synechia and a severe cell lost. But the success of this entity is possible and grafts can have very good viability. Any of our cases had undergone an iridotomy and we think it´s not necessary to prevent this complication. In our experience, the best prevention for this entity is the instillation of midriatics in addition to a strict supine position during the first 12 hours after the DSAEK.

Financial Interest:

NONE