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Kang and Kim: Clinical Outcomes of Combined Descemet-stripping Endothelial Keratoplasty and Intraocular Lens Exchange
Original Article

J Korean Ophthalmol Soc 2016;57(9):1361-1368.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.9.1361

Clinical Outcomes of Combined Descemet-stripping Endothelial Keratoplasty and Intraocular Lens Exchange

Dong Jin Kang, MD, Hong Kyun Kim, MD, PhD

Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea

Address reprint requests to Hong Kyun Kim, MD, PhD Department of Ophthalmology, Kyungpook National University Hospital, #130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea Tel: 82-53-200-5816, Fax: 82-53-426-6552 E-mail: okeye@knu.ac.kr

Received 24 March 2016       Revised 13 June 2016       Accepted 18 August 2016

Copyright © 2016 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate clinical outcomes after combined descemet-stripping endothelial keratoplasty (DSEK) and intraocular lens (IOL) exchange in a Korean population.

Methods

The medical records of 15 patients (15 eyes) with pseudophakic bullous keratopathy who underwent combined DSEK and IOL exchange from January 2011 to January 2015 and who were followed up for more than 12 months were reviewed retrospectively.

Results

In 14 eyes with successful results after surgery, the best corrective visual acuity (BCVA) was significantly improved from 2.01 ± 0.96 (log MAR, mean) to 0.68 ± 0.26 at 3 months (p = 0.001) except for one eye that received reoperation on the endothelial disc detachment. The BCVA at postoperative 6 and 12 months gradually increased (0.51 ± 0.26 and 0.40 ± 0.22 log MAR, mean). Central corneal thickness was significantly improved from 777 ± 139 μ m to 605 ± 28 μ m at 6 months (p = 0.003) and was maintained at 12 months. The mean endothelial cell count was 2,973 ± 281/mm2 in the donor lenticules and 1,790 ± 265/mm2 at 12 months. Endothelial cell loss was 40%. The target refraction was −0.81 ± 0.16 D and the 12 months postoperative spherical equivalent was −0.28 ± 0.36 D. Complications included intraocular pressure elevation in one eye and pupillary capture in one eye.

Conclusions

Combined DSEK and IOL exchange may be a very efficient and safe option for surgically managing pseudophakic bullous keratopathy.

Keywords: Descemet-stripping endothelial keratoplasty (DSEK), Intraocular lens (IOL) exchange, Pseudophakic bullous keratopathy, Scleral fixation

References

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Figure 1.
Changes in best corrected visual acuity (BCVA) after combined descemet-stripping endothelial keratoplasty and intraocular lens exchange. The BCVA improved at post-operative 3 months. * Wilcoxon signed rank test.
jkos-57-1361f1.tif
Figure 2.
Changes in central corneal thickness (CCT) after combined descemet-stripping endothelial keratoplasty and intraocular lens exchange. * Wilcoxon signed rank test.
jkos-57-1361f2.tif
Figure 3.
Changes in endothelial cell count (ECC) after combined descemet-stripping endothelial keratoplasty and intraocular lens exchange. * Wilcoxon signed rank test.
jkos-57-1361f3.tif
Table 1.
Characteristics of the patient who underwent combined descemet-stripping endothelial keratoplasty and intraocular lens (IOL) exchange
Case Age (years) Sex Diagnosis Associated ocular morbidity Cormorbidity Postop complication Remark
1 65 F IOL dislocation – HTN IOP elevation –
2 55 M IOL dislocation – – Pupillary capture –
3 74 M ACL Prev. RRD, Vit. eye HTN – –
4 71 M IOL dislocation Prev. uveitis DM, HTN – –
5 83 F ACL Glaucoma Hyperthyroidism – –
6 71 F IOL dislocation – – – –
7 61 M IOL dislocation ERM, CME – – –
8 83 M IOL dislocation Optic atrophy – – –
9 64 M ACL Glaucoma DM, HTN – –
10 71 M ACL CSC HTN – –
11 42 M IOL dislocation – DM, HTN – –
12 67 M ACL – – – –
13 77 M IOL dislocation CME – – –
14 50 M IOL dislocation – – – –
15 50 M ACL Prev. RRD, Vit. eye – Vitreous hemorrhage PKP after total Endothelial disc detachment

HTN = hypertension; IOP = intraocular pressure; ACL = anterior chamber lens; Prev. = previous; RRD = rhegmatogenous retinal detachment; Vit. eye = vitrectomized eye; DM = diabetes melitus; ERM = epiretinal membrane; CME = cystoid macular edema; CSC = chronic central serous chorioretinopathy; PKP = penetrating keratoplasty.

Table 2.
Pre- and postoperative best corrected visual acuity (BCVA, log MAR), keratometry and refractive error (D) at 12 months after operation
Case Preop BCVA Postop BCVA
 Preop Mean K (D) Postop Mean K (D) Target power (D) Refractive error (D)
 S/E (D)
3 months 6 months 12 months Spherical Cylinder
1 1.7 0.7 0.4 0.3 44.5 44.5 −0.79 +0.25 −1.0 −0.25
2 0.7 0.2 0.2 0.1 42.625 42.75 −0.85 +0.5 −1.25 −0.125
3 1.7 1.0 1.0 0.7 42.375 42.5 −0.94 +0.5 −1.5 −0.25
4 0.7 0.3 0.2 0.1 43.5 43.5 −0.87 +0.5 −1.75 −0.375
5 0.7 0.4 0.3 0.3 42.625 42.5 −0.82 −0.5 −0.5 −0.75
6 1.3 1.0 1.0 0.7 42.625 42.75 −1.22 0 −1.0 −0.5
7 3.0 1.0 0.7 0.7 43.25 43.25 −0.7 +0.5 −2.0 −0.5
8 3.0 1.0 0.7 0.7 43 43.25 −0.95 0 −1.0 −0.5
9 3 0.7 0.5 0.5 44.5 44.5 −0.58 +0.5 −1.5 −0.25
10 3 0.7 0.5 0.4 45.875 46 −0.63 +0.75 −1.25 0.125
11 3 0.7 0.5 0.3 44.875 45 −0.81 +1.0 −1.0 0.5
12 1.7 0.7 0.5 0.4 43.25 43.5 −0.71 +0.25 −2.0 −0.75
13 1.7 0.5 0.3 0.2 48.375 48 −0.64 +0.5 −0.5 0.25
14 3 0.7 0.4 0.3 45.75 46 −0.82 0 −1.0 −0.5
Mean 2.01 ± 0.96 0.68 ± 0.26 0.51 ± 0.26 0.40 ± 0.22 44.08 ± 1.70 44.21 ± 1.82 −0.81 ± 0.16 0.33 ± 0.37 −1.23 ± 0.47 −0.28 ± 0.36
p-value – 0.001* 0.001* 0.001* – 0.143 – – – 0.001*

Values are presented as mean ± SD unless otherwise indicated.

D = diopter; K = keratometry; Preop = preoperative; Postop = postoperative; S/E = spherical equivalent.

* Show statically significant difference compared to preoperative value (p < 0.05, Wilcoxon signed ranks test).

Table 3.
Pre- and postoperative central corneal thickness (CCT), donor and postoperative endothelial cell count
Case Preop CCT (μ m) Postop CCT (μ m)
 Donor ECC Postop ECC
6 months 12 months 6 months 12 months
1 678 N/D 587 2,631 N/D 1,686
2 654 N/D 585 3,150 2,405 2,324
3 724 N/D 607 3,297 N/D 1,443
4 705 582 594 2,278 1,542 1,499
5 1,184 542 521 3,003 N/D 2,141
6 799 621 615 3,040 1,675 1,536
7 654 633 608 3,055 1,854 1,774
8 752 624 595 3,352 1,799 1,693
9 907 589 578 2,950 N/D 2,119
10 842 612 588 3,254 2,004 1,992
11 707 593 598 2,842 1,671 1,585
12 684 632 604 2,975 1,974 1,832
13 798 634 623 2,777 N/D 1,624
14 785 594 575 3,024 1,876 1,813
Mean 777 ± 139 605 ± 28 591 ± 24 2,973 ± 281 1,866 ± 251 1,790 ± 265
p-value – 0.003* 0.001* – 0.008* 0.001*

Values are presented as mean ± SD unless otherwise indicated.

Preop = preoperative; Postop = postoperative; ECC = endothelial cell count; N/D = not done.

* Show statically significant difference compared to preoperative value (p < 0.05, Wilcoxon signed ranks test).

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