Endothelial cell loss and complication rates with combined Descemets stripping endothelial keratoplasty and cataract surgery in a UK centre

Abstract

Purpose To report 6-month, 1-and 2-year endothelial cell loss (ECL), intra-and postoperative complications in a large series of patients undergoing either Descemets stripping endothelial keratoplasty (DSEK) or a combined phacoemulsification and DSEK in a UK centre. Patients and methods Patients undergoing DSEK with or without concurrent cataract surgery were included in this retrospective study. Surgeries were performed between January 2006 and May 2013. Main outcomes included intra-and postoperative complications and percentage ECL.Results DSEK was performed in 226 eyes (210 patients). Of these, 141 eyes (126 patients) underwent DSEK alone and 85 eyes (84 patients) underwent DSEK combined with cataract surgery. Excluding complex anterior segment pathology the mean percentage ECL at 6, 12 and 24 months was 40.5 ± 13.4, 45.1 ± 14.6 and 53.1 ± 13.0 in the DSEK group and 40.7 ± 15.4, 42.6 ± 15.3 and 49.6 ± 16.5 in patients undergoing the combined procedure, respectively. There was no significant difference in percentage ECL at 6 or 24 months between the two groups both in complex and routine cases. Intraoperative complications occurred in four patients undergoing DSEK and three undergoing combined procedure. Postoperative complication rates did not reach statistical significance between the groups. Conclusion Mean ECL and complication rates were comparable at 6, 12 and 24 months in routine cases undergoing concurrent DSEK with cataract surgery and those undergoing DSEK. These data support the combined procedure in patients requiring both cataract surgery and endothelial keratoplasty. Further collaboration to report endothelial cell counts from other UK centres should be encouraged.

Descemet Stripping Automated Endothelial Keratoplasty

“…The complication rate and postoperative ECD for triple procedures compared to the DSAEK alone cases have not been shown to be different for short-term periods (6 months and 12 months) or longer-term follow-up of 3 to 5 years. [ 12 – 14 ] The 5 year ECL in our study (44.4%) was comparable to the 3 year ECL in the CPTS for the Fuchs dystrophy subgroup (44%). [ 12 ] The Price et al study reported a higher 5 year ECL at 53% compared to our study.…”

“…[ 9 , 10 ] However, there is a theoretical risk that the greater instability of the newly placed intraocular lens (IOL) in a triple procedure and the added postoperative inflammation from the concomitant cataract surgery may increase the endothelial cell loss rate in a triple procedure graft v a DSAEK without other simultaneous surgery. [ 11 ] While the Cornea Preservation Time Study [ 12 ] (CPTS) and other single center studies [ 13 , 14 ] did not show a significant difference in endothelial cell loss of Triples v DSAEK alone, the study presented here has a longer postoperative time frame than the CPTS and more patients to analyze for the 5 year postoperative visit than any prior single center study.…”

Management of Corneal Clouding in Patients with Mucopolysaccharidosis

“…Glaucoma following keratoplasty is relatively common, it can appear at any period in the evolution of the graft, it can be difficult to diagnose and to monitor and its treatment can hinder the progress of the transplant [ 50 ]. Simultaneous cataract surgery and keratoplasty could reduce the risk of anterior chamber angle compromise over time as well as in the immediate post-operative period [ 51 , 52 ].…”