Non-Descemet stripping automated endothelial keratoplasty for endothelial dysfunction secondary to argon laser iridotomy.
OBJECTIVE
To report clinical outcomes of non-Descemet stripping automated endothelial keratoplasty (nDSAEK) as treatment of endothelial dysfunction secondary to argon laser iridotomy (ALI).


METHODS
Single-center, prospective, noncomparative, interventional case series.


METHODS
Six eyes of six patients (two men, four women; mean age, 74.5 years) with bullous keratopathies secondary to ALI were treated with endothelial keratoplasty without recipient Descemet stripping. The donor endothelial lamella was inserted using a pull-through technique using a Busin glide with intraocular lens glide (i.e., Kobayashi double-glide technique). Best-corrected visual acuity (BCVA), astigmatism, and donor central endothelial cell density (ECD) were recorded before surgery and at six months after surgery. Intraoperative and postoperative complications also were recorded. Main outcome measures were preoperative and postoperative central ECD, with calculation of cell loss rate. BCVA, induced astigmatism, and complications also were evaluated.


RESULTS
All patients reached more than 20/32 BCVA, with two (33.3%) reaching 20/20. Mean induced astigmatism in measurable cases was 0.85 +/- 0.49 diopters. The average and standard deviation ECD at six months were 2390.5 +/- 522.4 cells/mm(2) (range, 1589 to 2898 cells/mm(2)), representing a mean cell loss from preoperative donor cell measurements of 25.8% +/- 14.7%. Complications included one case of donor dislocation requiring rebubbling (16.7%) and one case of subclinical endothelial rejection (16.7%).


CONCLUSIONS
This modified endothelial keratoplasty technique (nDSAEK and double-glide technique) for treatment of endothelial dysfunction secondary to ALI produced excellent clinical outcomes such as reduced endothelial cell loss, good visual acuity, and minimal induced astigmatism.
Kobayashi
Akira
A
Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. kobaya@kenroku.kanazawa-u.ac.jp
Yokogawa
Hideaki
H
Sugiyama
Kazuhisa
K
D000368:Aged; D000369:Aged, 80 and over; D001251:Astigmatism / Q000503:physiopathology; D002452:Cell Count; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery; D004728:Endothelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D006801:Humans; D032801:Iridectomy; D007498:Iris / Q000601:surgery; D054020:Lasers, Gas / Q000009:adverse effects*; D019654:Lens Implantation, Intraocular; D008297:Male; D018918:Phacoemulsification; D011183:Postoperative Complications; D011446:Prospective Studies; D014019:Tissue Donors; D014792:Visual Acuity / Q000502:physiology