Outcomes of endothelial keratoplasty performed in combination with, before or after cataract surgery in Fuchs' endothelial dystrophy

Session Details

Session Title: Surgical Cornea: Keratoplasty & Corneal Grafts

Session Date/Time: Sunday 23/09/2018 | 14:00-16:00

Paper Time: 15:24

Venue: Room A3, Podium 3

First Author: : H.Lee UK

Co Author(s): :    J. Phee   A. Bardan   M. Nanavaty              

Abstract Details

Purpose:

Fuchs Endothelial Dystrophy (FECD) is a leading indication for Endothelial Keratoplasty (EK), which could be Descemets stripping automated EK (DSAEK) or Descemets membrane EK (DMEK). We performed a literature review to assess the outcomes of EK in combination with, before or after cataract surgery.

Setting:

Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, UK. BN2 5BF

Methods:

Literature searches were conducted in MEDLINE® and EMBASE between 2000 and 2017 Week 33. The studies were categorized as EK performed in combination with cataract surgery (category 1), or as a staged procedure before (category 2) or after cataract surgery (category 3). The primary outcome was best-corrected visual acuity (BCVA) and the secondary outcomes included: spherical equivalent (SEQ), refractive astigmatism (RA), endothelial cell density (ECD), pachymetry, re-bubbling rate, graft rejection and failure.

Results:

Follow-up in categories varied from 1 hour to 14.33±2.15 months. In category 1, 2 and 3, postoperative logMAR BCVA was 0.19±0.13, 0.13±0.04 and 0.14±0.10 and ECD was 1847.6±216, 1791±317 and 1831±291 cell/mm2 respectively. Categories 1, 2 and 3 reported rebubbling rates of 25.1%, 33% and 17.7% respectively and majority of eyes showed hyperopic shift. Refractive astigmatism outcomes were variable and DSAEKs had increased pachymetry compared to DMEKs. Mean graft rejection rates were 4.75±6.6%, 0% and 0% whereas graft failure 1.7±2.%, 0% and 1.45±1.56% in category 1, 2 and 3 respectively.

Conclusions:

Postoperative BCVA was comparable in all three categories. ECD was lowest in category 2 and most patients would be expected to have hyperopic shift. Re-bubbling rates were variable in all categories. Graft rejection and failures were highest in category 1. Further research on efficacy and safety of three different approaches are needed. Our work may be used for future counselling with patients about outcome and complication rates to make an informed decision.

Financial Disclosure:

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