Study of factors for unsuitability of DSAEK in cases of corneal decompensation following cataract surgery

Abstract

To evaluate suitability of Descemet's stripping automated endothelial keratoplasty (DSAEK) in cases of corneal decompensation following cataract surgery. In this cross-sectional case series, 90 eyes of 90 patients were evaluated at a tertiary eye care centre. Cases with central corneal scarring or vascularisation, complicated aphakia with significant iris tissue defects and extensive synechaie or posterior segment pathology precluding visual recovery were classified as unsuitable for DSAEK. Of 90 eyes, 42 (46.67%) were unsuitable for DSAEK. Multivariate logistic regression analysis, revealed that patients presenting more than a year after cataract surgery had 7.5-fold odds of being unsuitable for DSAEK as compared with those who presented earlier(OR 7.5; CI 2.0-29.1). Patients with BCVA poorer than 0.06 at initial presentation had 5.0 times odds of being unsuitable for DSAEK (OR 5.0; CI 1.0-24.2). Patients who had prior non-phacoemulsification cataract surgery were 5.5 times less likely to be candidates for DSAEK as compared to those who had prior phacoemulsification (OR 5.5; CI 1.5-19.9) and those with anterior chamber IOL or aphakia were 5.0 times less likely suitable for DSAEK, in contrast to posterior chamber intraocular lenses (OR 5.0; CI 1.3-18.7). The type of cataract surgery, time to presentation and initial visual acuity play a role in determining the suitability of performing DSAEK in patients with corneal decompensation after cataract surgery.

<p>Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization</p>

“…Unlike most of the published series in DMEK, the majority of our cases present at a delayed stage of corneal endothelial decompensation making them either unsuitable or surgically challenging for an endothelial keratoplasty. 10 Several modifications have been suggested to overcome the difficulty of poor visualization. Burkhart et al described the use of intraoperative handheld slit lamp in these cases; however surgical sterility is at risk along with interruption of the surgical procedure with its use.…”

Anterior Segment Optical Coherence Tomography–Guided Management Algorithm for Descemet Membrane Detachment After Intraocular Surgery

“…In previous studies, air, SF 6 gas, or C 3 F 8 gas has been used to tamponade detached DMs. 15,16,[19][20][21] Animal studies seem to show a similar endothelial toxicity profile for all 3 gases. 22 No studies have compared the endothelial toxicity between air, C 3 F 8 , and SF 6 gas in a randomized controlled trial in such cases.…”

“…We used air and C 3 F 8 because these were the most common agents used to tamponade detached DMs in the previous studies. 15,16,[19][20][21] The mean time of resolution of corneal edema was 16 6 7 days. Using ASOCT images, the morphology and location of the DMD were delineated better.…”

“…12,16,17 It can scan through a relatively opaque cornea, and minimal experience is required for image acquisition, hence making it an indispensable tool in corneal disorders especially in cases of corneal edema in the postoperative period during which a definitive diagnosis is required to plan appropriate management.…”

“…11,13,14 In all patients in whom DMD was documented, descemetopexy was performed using intracameral air or 14% perfluoropropane (C 3 F 8 ) with a standard technique under the operating microscope. 15,16 DMDs that were in the superior half of the cornea with a planar configuration alone were managed using intracameral air (Fig. 1), and those with scrolled edges were managed using intracameral 14% perfluoropropane (C 3 F 8 ) (Fig.…”