Endothelial keratoplasty for bullous keratopathy in eyes with an anterior chamber intraocular lens

Liarakos, Vasilios S.; Ham, Lisanne; Dapena, Isabel; Tong, C. Maya; Quilendrino, Ruth; Yeh, Ru-Yin; Melles, Gerrit R.J.

doi:10.1016/j.jcrs.2013.05.045

Cited by 49 publications

(45 citation statements)

References 26 publications

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“…In this study, PBK (17 eyes, 38.6%) was the most common indication, in accordance with Mamalis et al (3) and Doren et al (4) , for AC IOL explantation, which had a rate of 47.3%. Preventing the need for penetrating keratoplasty, AC IOL explantation has been indispensable in eyes with signs of progressive corneal endothelial damage (6) . In our series, intervals between surgeries in patients with PBK and persistent iritis were 126.7 ± 89.7 months (range: 6-276 months) and 41.4 ± 38.6 months (range: 2-120 months), respectively.…”

Section: Discussionmentioning

confidence: 99%

Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes

Oltulu¹,

Erşan²,

Şatırtav³

et al. 2015

Arquivos Brasileiros De Oftalmologia

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Cataracts are one of the most common eye diseases associated with blindness (visual acuity worse than 20/400 in the better eye with best correction) worldwide, with an estimated 18 million people thought to be affected, and cataract surgery is the intraocular procedure performed most often worldwide. Over the years, the techniques of cataract surgery have evolved into a safe and successful procedure for visual rehabilitation. The incidence of most complications has significantly decreased with the development of better instrumentation and affordable, high-quality intraocular lens (IOL) implants (1) . Various aspects of cataract surgery that make it safer have changed ABSTRACT Purpose: To analyze the indications for explantation or exchange of intraocular lenses (IOLs), which were originally implanted for the correction of aphakia during cataract extraction. Methods: All cases that involved intraocular lens explantation or exchange in one institution between January 2008 and December 2014 were analyzed re tros pectively. Results: In total, 93 eyes of 93 patients were analyzed. The median time interval between implantation and explantation of the anterior chamber intraocular lenses (AC IOL) and posterior chamber intraocular lenses (PC IOL) was 83.40 ± 83.14 months (range: 1-276 months) and 55.14 ± 39.25 months (range: 1-168 months), respectively. Pseudophakic bullous keratopathy (17 eyes, 38.6%) and persistent iritis (12 eyes, 27.8%) in the AC IOL group and dislocation or decentration (30 eyes, 61.2%) and incorrect IOL power (nine eyes, 18.4%) in the PC IOL group were the most common indications for explantation of IOLs. The mean logMAR best corrected visual acuity (BCVA) improved significantly from 1.30 preoperatively to 0.62 postoperatively in the PC IOL group (p<0.001) but did not improve significantly in the AC IOL group (p=0.186). Conclusions:The primary indication for IOL explantation or exchange was pseudophakic bullous keratopathy in the AC IOL group and was dislocation or decentration in the PC IOL group. PC IOL explantation or exchange is safe and im proves visual acuity.

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Section: Discussionmentioning

confidence: 99%

Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes

Oltulu¹,

Erşan²,

Şatırtav³

et al. 2015

Arquivos Brasileiros De Oftalmologia

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“…In the group with ACIOLs, all of the transplants were successful, including the one case performed over the ACIOL that had been left in place. This article suggests a possible role for DMEK in the presence of iris claw lenses as well as combined with removal of an anterior chamber lens in phakic patients [9]. We do not perform DMEK in the setting of ACIOL.…”

Section: Anterior Chamber Intraocular Lensmentioning

confidence: 98%

“…The existing literature on DMEK in ACIOL cases consists of a series of 14 eyes from Liarakos et al [9] reviewing their experience with DMEK in six eyes with iris claw IOLs and eight phakic patients with angle-supported lenses, of which all but one of the ACIOLs were removal prior to DMEK. Five of six DMEK procedures done in the setting of an iris claw IOL were deemed successful, with one case requiring replacement with DSAEK.…”

Section: Anterior Chamber Intraocular Lensmentioning

confidence: 99%

“…Despite this coming shift toward DMEK in uncomplicated endothelial keratoplasty, the greater relative versatility of DSAEK will necessitate its continued utilization as the endothelial keratoplasty procedure of choice in eyes with a number of comorbid conditions that limit the role of DMEK. At the time of publication, there are only limited reports supporting the role of DMEK in complex endothelial keratoplasty scenarios, such as under penetrating keratoplasty and in the presence of anterior chamber intraocular lenses (ACIOL) [9][10][11]. Notably however, there is also a growing body of cautionary opinions advising against the application of DMEK in a number of comorbid conditions [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Evolving indications for Descemetʼs stripping automated endothelial keratoplasty

Veldman

Terry

Straiko

2014

Current Opinion in Ophthalmology

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The increasing adoption of Descemet's membrane endothelial keratoplast is changing the practice of endothelial keratoplasty. However, limitations of the Descemet's membrane endothelial keratoplasty procedure have also served to crystallize the essential role of Descemet's stripping automated endothelial keratoplasty in many complex endothelial keratoplasty scenarios. This article will review indications for endothelial keratoplasty, along with the current evidence for Descemet's stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty in their management.

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“…Additionally, as we mentioned earlier in this chapter, DSAEK (especially the socalled 'ultrathin' techniques) and, in particular circumstances, PKP, should be included in our surgical armamentarium because they will be more appropriate for some surgeons in selected cases [96] . Although most of us prefer to perform DMEK on uncomplicated pseudophakic eyes, the triple procedure is also commonly performed worldwide [97] , and we already know that cataract surgery after DMEK can be successfully performed, with no increased risk of detachment [98] .…”

Section: Comments About the Descemet Membrane Endothelial Keratoplastmentioning

confidence: 99%

Descemet Membrane Endothelial Keratoplasty: Update on Endothelial Transplantation Techniques

Güell¹,

Husseiny²,

Morral³

et al. 2015

Cornea

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The cornea remains in a state of deturgescence, maintained by the endothelial cell Na+/K+ ATPase and by tight junctions between endothelial cells that limit the entrance of fluid into the stroma. By maintaining an optimum level of corneal hydration, endothelial cells preserve the ordered arrangement of collagen fibers, which is crucial for corneal transparency. Fuchs' endothelial corneal dystrophy (FECD) was initially described by Fuchs in 1910 as a combination of epithelial and stromal edema in older patients. It manifests itself as bilateral, albeit asymmetric, central corneal guttae, corneal edema, and reduced vision. The Descemet membrane thickens and develops excrescences known histopathologically as guttae. Stromal edema develops, and the corneal thickness may increase to over 1,000 μm. When the edema is severe, the corneal epithelium can detach from its basement membrane, creating painful bullae on the anterior surface of the cornea. FECD is the most common endothelial dystrophy and is usually seen beyond the fifth decade of life, although not all cases are in the elderly. Pseudophakic bullous keratopathy is a term used to describe endothelial cell loss caused by surgical manipulations in the anterior chamber (usually due to pseudophakic intraocular lens (IOL) implantation, but it may be related to any other intraocular surgical procedure, obviously including phakic IOL implantation). If the corneal endothelium is damaged during surgery (as often occurs during cataract extraction, phakic IOL implantation and other procedures), the same spectrum of symptoms as found in FECD can develop, although the histological phenotype of both diseases is different and, usually, there is no guttata in pseudophakic bullous keratopathy. Full-thickness grafts have been the standard of care for treating medically uncontrollable endothelial disease for a significant number of years worldwide. However, although the success rate is 90% in low-risk patients, it is only 30-50% in more complex, higher-risk cases, and overall, 30% of cases have a rejection episode. Moreover, regrafting has become the most common indication for corneal transplantation in the US and in some places in Europe. The more recently developed lamellar keratoplasty techniques are designed to overcome some of the problems of corneal transplantation by leaving as much of the healthy cornea in place as possible. For example, endothelial keratoplasty procedures replace only the endothelium but leave the patient's cornea's refraction as well as most of its biomechanical properties fairly intact. In this chapter, we will review the actual techniques for endothelial transplantation and Güell JL (ed): Cornea.103 provide an update on the surgical strategy (mostly for Descemet membrane endothelial keratoplasty) and its clinical results and complications.

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Endothelial keratoplasty for bullous keratopathy in eyes with an anterior chamber intraocular lens

Cited by 49 publications

References 26 publications

Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes

Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes

Evolving indications for Descemetʼs stripping automated endothelial keratoplasty

Descemet Membrane Endothelial Keratoplasty: Update on Endothelial Transplantation Techniques

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