title: Endothelial keratoplasty for Fuchs' dystrophy with cataract: complications and clinical results with the new triple procedure.
abstract: OBJECTIVE
  To report the immediate postoperative complications and the 6- and 12-month clinical results in a large series of cases undergoing the new triple-procedure Descemet's stripping automated endothelial keratoplasty (DSAEK) and concurrent cataract surgery.
  
  
  METHODS
  Prospective, noncomparative, interventional case series.
  
  
  METHODS
  Three hundred fifteen eyes of 233 patients with Fuchs' corneal dystrophy were evaluated for the complications of dislocation and iatrogenic primary graft failure (IPGF). Two hundred three eyes of 149 patients had 6-month postoperative data available for other outcome analysis.
  
  
  METHODS
  A standardized technique of DSAEK with extensive use of cohesive viscoelastic was performed in all 315 eyes with Fuchs' dystrophy, and 225 of those eyes had cataract surgery concurrently. Of the 203 eyes with 6-month data, concurrent phacoemulsification with intraocular lens placement (triple procedure) was performed in 149 of those eyes.
  
  
  METHODS
  The complications of graft dislocation and IPGF were recorded for all eyes. Six- and 12-month postoperative best spectacle-corrected visual acuity (BSCVA), refractive spherical equivalent (SE), and central donor endothelial cell density (ECD) were measured prospectively and then compared with preoperative values for the triple-procedure eyes.
  
  
  RESULTS
  There were 4 dislocations (4%) among the 90 straight DSAEK cases and 4 dislocations (1.8%) among the 225 triple-procedure cases (P = 0.327). There was not a single case of IPGF in any of the 315 DSAEK cases. After the triple procedure, the BSCVA in eyes without comorbidity (n = 122) improved with 93% at 20/40 or better at 6 months and 97% at 20/40 or better at 12 months. Refractive SE at 6 months averaged 0.11+/-1.08 diopters (D), with 73% of eyes within 1 D of emmetropia and 95% within 2 D of emmetropia. The postoperative mean ECD was 1955 cells/mm(2) at 6 months (n = 125) and 1979 cells/mm(2) at 12 months (n = 89) and represented a 32% cell loss from that before surgery (P<0.001) for both postoperative time points.
  
  
  CONCLUSIONS
  The new triple-procedure DSAEK combined with cataract surgery provides rapid visual recovery and allows selection of an appropriate intraocular lens. Dislocations are rare (1.8%) and primary graft failure did not occur.
authors.affiliation: Devers Eye Institute, Portland, Oregon 97210, USA. mterry@deverseye.org
authors.forename: Mark A
authors.initials: MA
authors.lastname: Terry
authors.forename: Neda
authors.initials: N
authors.lastname: Shamie
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Chen
authors.forename: Paul M
authors.initials: PM
authors.lastname: Phillips
authors.forename: Anand K
authors.initials: AK
authors.lastname: Shah
authors.forename: Karen L
authors.initials: KL
authors.lastname: Hoar
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Friend
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications*; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000150:complications / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome; D055682:Viscoelastic Substances / Q000008:administration & dosage; D014792:Visual Acuity
chemical_list: D055682:Viscoelastic Substances