Descemet-Stripping Automated Endothelial Keratoplasty Versus Triple Procedure: Visual Outcomes and Complications

1. Descemet-Stripping Automated Endothelial Keratoplasty Versus Triple Procedure: Visual Outcomes and Complications Toby Chan MD, BSc Alexander C. Tokarewicz MD, FRCSC University of Western Ontario, London, Ontario, Canada Disclosure: The authors have no financial interest in the subject matter of this e-poster.

2. Background • Descemet-stripping automated endothelial keratoplasty (DSAEK) has shown benefits over penetrating keratoplasty (PKP) for surgical treatment of endothelial dystrophy or dysfunction • Triple procedure combining DSAEK, phacoemulsification, and intraocular lens implantation may result in rapid visual rehabilitation with minimal surgically-induced astigmatism or ametropia

3. Purpose • To examine the visual outcome and complications after: DSAEK with concurrent phaco and IOL implant (triple procedure) DSAEK alone VS

4. Methods • Study design: Retrospective comparative case series • Exclusion: Cases with < 3 months of follow-up post-op • All cases were performed by a corneal surgeon (A.C.T.) at the Ivey Eye Institute in London Ontario from October 2007 to October 2009. • DSAEK: 10 eyes • Triple procedure: 11 eyes

5. Methods • The following parameters were examined and compared between the two groups: Spherical equivalent (SE) @ 3 months Best-corrected visual acuity (BCVA) @ 3 months Final SE and BCVA Post-op complications Patient gender Pre-operative diagnosis Age at surgery Donor age Wait time for surgery Length of post-op follow-up

6. Results – baseline data Table 1. Baseline data on patients who had DSAEK (n=10) and triple procedure (n=11). PBK = pseudophakic bullous keratopathy

7. Results Fig. 1. Age at surgery (years), donor age (years), surgery wait time (months) and post-operative follow-up (months) for both groups. No significant difference was found between groups using t-test (P >0.05, NS)

8. Visual outcome Table 2. Interim and final visual outcome for both groups. No significant difference was found when comparing SE values between groups (t-test, P>0.05, NS). BCVA = best-corrected visual acuity (Snellen), SE = spherical equivalent

9. Complications Table 3. Complications in both groups. IOP rise was seen in 50% of DSAEK cases, all of which resolved with topical anti-glaucoma medications.

10. Conclusions • Rapid visual recovery and similar visual outcomes were achieved by both surgical approaches: triple procedure and DSAEK alone. • With increasing popularity, DSAEK combined with cataract surgery can be successfully performed with low complication rates. • Special attention should be paid to patients with pre-existing glaucoma as DSAEK may result in iatrogenic intraocular pressure rise.

11. References 1) Lombardo M, Terry MA, Lombardo G, Boozer DD, Serrao S, Ducoli P. Analysis of posterior donor corneal parameters 1 year after Descemet stripping automated endothelial keratoplasty (DSAEK) triple procedure. Graefes Arch Clin Exp Ophthalmol. 2010 Mar;248(3):421-7. 2) Shih CY, Ritterband DC, Rubino S, Palmiero PM, Jangi A, Liebmann J, Ritch R, Seedor JA. Visually significant and nonsignificant complications arising from Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2009 Dec;148(6):837-43. 3) Terry MA, Shamie N, Chen ES, Phillips PM, Shah AK, Hoar KL, Friend DJ. Endothelial keratoplasty for Fuchs' dystrophy with cataract: complications and clinical results with the new triple procedure. Ophthalmology. 2009 Apr;116(4):631-9. 4) Covert DJ, Koenig SB. New triple procedure: Descemet's stripping and automated endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation. Ophthalmology. 2007 Jul;114(7):1272-7.