New triple procedure: Descemet's stripping and automated endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation.
OBJECTIVE
To evaluate visual acuity (VA), graft clarity, and refractive outcome of Descemet's stripping and automated endothelial keratoplasty (DSAEK) combined with phacoemulsification and intraocular lens (IOL) implantation in patients with coexisting Fuchs' endothelial dystrophy and immature senile cataracts.


METHODS
Pilot, prospective, noncomparative, surgical case series.


METHODS
Twenty-one eyes of 21 consecutive patients with coexisting visually significant immature senile cataracts and Fuchs' corneal dystrophy with guttata of Descemet's membrane and either microcystic epithelial edema or stromal edema presenting to a single academic eye institute.


METHODS
All patients underwent phacoemulsification and posterior chamber IOL implantation through temporal clear corneal incision, followed by DSAEK. The intent was to render all eyes as close to emmetropia as possible.


METHODS
Six-month postoperative best spectacle-corrected VA (BSCVA), refractive spherical equivalent (SE), refractive astigmatism, and keratometry.


RESULTS
Average BSCVAs were 20/68 preoperatively and 20/34 postoperatively (P<0.0001). The postoperative SE refractive error was +0.45 diopters (D), on average +1.13 D more hyperopic than predicted by preoperative lens power calculations. Overall, 13 patients (62%) were within 1.00 D and 21 (100%) were within 2.00 D of emmetropia postoperatively. Preoperative and postoperative average refractive astigmatisms were 1.46 D and 1.56 D, respectively (P = 0.69). Complications included graft dislocations requiring repositioning (3), 2 of which experienced recurrent dislocation requiring reoperation with a new graft; acute graft rejection (3); and pupillary block glaucoma (2).


CONCLUSIONS
This pilot case series of 6-month results of DSAEK combined with phacoemulsification and IOL implantation suggests that it provides rapid visual rehabilitation with predictable refractive outcomes.
Covert
Douglas J
DJ
Eye Institute, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin, USA.
Koenig
Steven B
SB
D000368:Aged; D000369:Aged, 80 and over; D001331:Automation; D002386:Cataract / Q000150:complications*; D002387:Cataract Extraction; D016039:Corneal Transplantation; D003886:Descemet Membrane / Q000601:surgery*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D010865:Pilot Projects; D011184:Postoperative Period; D011446:Prospective Studies; D012029:Refraction, Ocular; D016896:Treatment Outcome; D014792:Visual Acuity