Effects of Cataract Surgery on Endothelium in Transplanted Corneal Grafts

Zhou, Huixin; Xie, Lixin

doi:10.4103/0366-6999.189050

Cited by 11 publications

(3 citation statements)

References 18 publications

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“…Combined and sequential surgeries were performed by the two experienced surgeons. The surgical steps of PK combined ECCE with IOL implantation and sequential cataract surgery (ECCE combined with IOL implantation) after PK were consistent with our previous studies reported (12,13).…”

Section: Surgical Technique and Clinical Caresupporting

confidence: 89%

Combined versus sequential penetrating keratoplasty and cataract surgery for herpes simplex keratitis: a retrospective study

Wang,

Cheng,

Yang

et al. 2023

Front. Med.

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PurposeTo compare the surgical outcomes of combined penetrating keratoplasty (PK) and cataract surgery with those of sequential surgery (cataract surgery after PK) for herpes simplex keratitis (HSK).MethodsThe medical records of consecutive patients diagnosed with HSK who underwent combined or sequential PK and cataract surgery in active and stable stages between June 2015 and June 2022 were reviewed retrospectively. Complications, graft survival, endothelial cell density (ECD), and final BCVA were compared and analyzed between both surgical methods in each stage.ResultsA total of 171 eyes of 171 patients were enrolled, including active stage (69 combined, 46 sequential) and stable stage (34 combined, 22 sequential). The average follow up was 24.2 ± 15.8 months (range, 3 months – 48 months). The final BCVA had obvious improvement and the postoperative ECD was not different in combined and sequential groups of each stage. In sequential group of active stage, 66.7% of persistent epithelial defects and 50% of HSK recurrence occurred within 3 months after cataract surgery; nevertheless, compared to that in sequential group, capsular rupture (p = 0.021), persistent epithelial defects (p = 0.027), and HSK recurrence (p = 0.035) occurred more frequently in combined group, leading to a lower graft survival rate (p = 0.045); at the last visit, 46.4 and 67.4% of grafts remained clear in combined and sequential groups, respectively. By contrary, 82.4 and 50.0% of grafts remained clear in stable stages of combined and sequential groups at the last visit, respectively, and a higher graft survival rate was observed in combined group (p = 0.030).ConclusionAlthough the postoperative ECD is not different between two surgical groups in each stage, sequential surgery in active stage of HSK seems to have advantages in less complications and higher graft survival rate, whereas combined surgery in stable stage has a better outcome than that in sequential surgery.

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Section: Surgical Technique and Clinical Caresupporting

confidence: 89%

Combined versus sequential penetrating keratoplasty and cataract surgery for herpes simplex keratitis: a retrospective study

Wang,

Cheng,

Yang

et al. 2023

Front. Med.

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“…In addition, cataract surgery after endothelial keratoplasty variably reduces the ECD. [28][29][30][31][32] Even though there is accelerated cataract formation after endothelial keratoplasty, some authors see advantages in sequential procedure in which first a DMEK and then cataract surgery is performed. Price et al prefer the 2-step procedure for best-possible refractive outcome 33 because there is a hyperopic shift after endothelial keratoplasty 3,34,35 as a reversal of a preoperative myopic shift due to corneal edema 36 and intraocular lens calculation is more precise after DMEK.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Pseudophakic, Phakic, and Triple DMEK

Moshiri

Karimi-Golkar

Schrittenlocher

et al. 2021

Cornea

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To evaluate the outcome of phakic and pseudophakic eyes treated by Descemet membrane endothelial keratoplasty (DMEK) versus DMEK combined with cataract surgery (triple DMEK). Methods: Retrospective cohort study based on the prospectiveCologne DMEK data base. This study is a single-center analysis of 62 eyes undergoing phakic (age mean 6 SD 52 6 6.43), 518 eyes undergoing pseudophakic (73.5 6 8.57), and 557 eyes undergoing triple DMEK (67.93 6 8.57). Outcome measures were changes in best spectacle-corrected visual acuity (BSCVA), central corneal thickness, endothelial cell density (ECD), rebubbling rates within the first year after surgery, and the need for cataract surgery within the first 2 years after phakic DMEK. Results:The preoperative BSCVA (mean 6 SD; logarithm of the minimum angle of resolution) was 0.30 6 0.22 in the phakic, 0.63 6 0.45 in the pseudophakic, and 0.44 6 0.30 in the triple DMEK group (P , 0.001), which changed to 0.09 6 0.12, 0.14 6 0.1, and 0.1 6 0.1 (P , 0.001) 1 year after surgery, respectively. There was no difference in central corneal thickness (P = 0.929) and endothelial cell density (P = 0.606) 1 year postoperatively. Rebubbling rates in DMEK using SF6 20% for anterior chamber tamponade were not significantly different (P = 0.839). After phakic DMEK, 40% of eyes underwent cataract surgery within the second year. However, there was a high loss to follow-up in this group.Conclusions: Phakic and triple DMEK procedures tend to have a better 1-year BSCVA than pseudophakic DMEK, with no differences in all other parameters analyzed. However, patients from the pseudophakic DMEK group were older and already had worse BSCVA before surgery.

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“…[3][4][5][6][7][8][9][10][11] This can lead to severe corneal edema and decreased corneal transparency and subsequently to the need for a secondary corneal surgery using lamellar techniques, or more rarely penetrating keratoplasty due to the inability for human CECs to divide. 12 Reducing the occurrence of this complication requires a better understanding of its root causes. Several causative factors for CEC damage related to phacoemulsification have been suggested but have not been studied in a consistent, comparable manner.…”

mentioning

confidence: 99%