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Early Outcomes of DSAEK in Pseudophakic Eyes with Anterior Chamber IOLs

Early Outcomes of DSAEK in Pseudophakic Eyes with Anterior Chamber IOLs. Hong A, Boehlke CS, Afshari NA, Kim T Duke University Medical Center Authors have no financial interest. Background.

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Early Outcomes of DSAEK in Pseudophakic Eyes with Anterior Chamber IOLs

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  1. Early Outcomes of DSAEK in Pseudophakic Eyes with Anterior Chamber IOLs Hong A, Boehlke CS, Afshari NA, Kim T Duke University Medical Center Authors have no financial interest

  2. Background • DSAEK has significant advantages over standard penetrating keratoplasty in the management of corneal endothelial disorders • Faster Visual Rehabilitation • More predictable corneal power • Preserves the structural integrity of the eye • Decreased suture-related complications

  3. This technique has gained widespread popularity for use in phakic and pseudophakic eyes with posterior chamber IOLs • The role of DSAEK in eyes with anterior chamber IOLs (ACIOLs) remains unclear • Generally considered a surgical contraindication due to higher risk of surgical complications and graft failure • Reduced space in the anterior chamber • Escape of air posteriorly through the peripheral iridectomy • Greater potential for vitreous interference • Possibly greater surgical manipulation of donor tissue • May necessitate an IOL exchange (iris- or scleral-sutured IOL)

  4. Purpose • To report on the early results of DSAEK in eyes with pre-existing ACIOLs • To evaluate the visual outcomes, refractive changes, and complications in this patient population

  5. Methods • Retrospective case study • Nine eyes of 9 patients with ACIOLs that subsequently developed corneal edema requiring DSAEK were identified from May 2005 to February 2008. • The host Descemetmembrane was stripped followed by insertion of a microkeratome-dissected donor endothelial graft that was delivered through a 3-mm corneal incision. Donor adherence to the host cornea was maximized by air tamponade and graft interface venting incisions. • Best spectacle-corrected visual acuity (BSCVA), manifest refraction, donor dislocation and graft failure rates were measured up to 12 months after DSAEK.

  6. Preoperative Clinical Data

  7. Refractive Outcomes

  8. Visual Outcomes and Comorbidities

  9. Complications

  10. Conclusions • Average visual outcomes of DSAEK in eyes with ACIOLs may be comparable to vision after DSAEK with posterior chamber IOLs. • Patients with ACIOLs may still be good candidates for DSAEK if they meet the ideal surgical criteria of a deep chamber, no vitreous interference, absent peripheral anterior synechiae, and the ability to maintain air tamponade for a prolonged period • DSAEK in eyes with ACIOLs can result in excellent visual outcomes with rapid visual recovery and may eliminate the need for an IOL exchange

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