Descemet-stripping automated endothelial keratoplasty in eyes with transscleral-sutured intraocular lenses

Abstract

PURPOSE: To compare the clinical outcomes and complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) with a transscleral-sutured intraocular lens (IOL) and solitary DSAEK. SETTING: Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. DESIGN: Retrospective case series. METHODS: Cases with simultaneous transscleral-sutured IOLs or post-transscleral-sutured IOLs and solitary DSAEK cases were studied. The logMAR acuity, astigmatism, endothelial cell density (ECD), graft survival rate, and complications (eg, IOL dislocation, cystoid macular edema [CME]) were analyzed. RESULTS: Thirty-seven DSAEK cases with simultaneous transscleral-sutured IOLs or post-transscleral-sutured IOLs and 147 solitary DSAEK cases were evaluated. The logMAR corrected distance visual acuity (CDVA) improved significantly at 24 months, from 1.34 ± 0.49 (SD) to 0.48 ± 0.38 after DSAEK with transscleral-sutured IOLs and from 1.17 ± 0.69 to 0.17 ± 0.25 after solitary DSAEK. The logMAR CDVA after DSAEK with transscleral-sutured IOLs was significantly worse than that with solitary DSAEK at 6, 12, and 24 months (P < .01). The postoperative astigmatism with DSAEK with transscleral-sutured IOLs was significantly higher than with solitary DSAEK because of the larger sclerocorneal incision (P < .02). There were no significant differences in ECD or graft survival rates between DSAEK with transscleral-sutured IOLs and solitary DSAEK. The incidence of CME in DSAEK with transscleral-sutured IOLs (4/37 eyes [11%]) was higher than with solitary DSAEK (2/147 [1.4%]) (P = .02). The CME resolved with topical diclofenac and sub-Tenon injection of triamcinolone acetonide in all eyes. CONCLUSION: The graft survival rates after DSAEK with transscleral-sutured IOLs were equivalent to those after solitary DSAEK, although the incidence of CME was higher than after solitary DSAEK. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.