Descemet stripping endothelial keratoplasty after Ophtec 311 iris reconstruction lens implantation.
OBJECTIVE
To describe the variations in intraoperative technique, postoperative complications, and visual outcomes associated with Descemet stripping endothelial keratoplasty (DSEK) after Ophtec iris reconstruction lens implantation.


METHODS
Retrospective, interventional, consecutive case series.


METHODS
Patients who underwent DSEK after Ophtec 311 iris reconstruction lens implantation at the Jules Stein Eye Institute, University of California, Los Angeles.


METHODS
Medical records were reviewed for demographic information, ophthalmic history, DSEK surgical technique, and postoperative clinical course.


METHODS
Intraoperative and postoperative complications and visual outcomes.


RESULTS
Four patients were identified (1 man and 3 women, age: 43-78). Three of the eyes had undergone prior penetrating keratoplasty (PKP), and each of the eyes had a history of glaucoma, with previous glaucoma surgery having been performed in 2 of the eyes. No intraoperative complications were encountered during the procedures, although an unplanned anterior vitrectomy was required in a previously vitrectomized eye. In each case, a complete air fill of the globe was obtained to ensure adherence of the donor button, and in 3 of the 4 cases, the donor button was sutured to the recipient cornea to prevent potential posterior dislocation. None of the cases developed donor button dislocation or primary graft failure. Corrected distance visual acuities improved to 20/40-20/160, corresponding to a mean improvement of 0.25 (range, 0.12-0.40), limited by irregular corneal astigmatism and advanced glaucomatous optic neuropathy. During a mean follow-up period of 15.6 months (range, 4.9-24.8 months), graft rejection developed in 2 of the 3 eyes with a history of endothelial rejection after PKP (0.42 episode per eye-year). Both of these eyes developed secondary graft failure, which also developed 14 months after DSEK in the other eye with a history of PKP failure before DSEK.


CONCLUSIONS
DSEK can be successfully performed in eyes with partial or complete aniridia, such as those after Ophtec iris reconstruction lens implantation. Modifications to the standard DSEK technique increase the probability of successful donor adherence and decrease the risk of posterior dislocation of the donor corneal button. However, endothelial rejection may occur at an increased frequency, resulting in secondary graft failure.
Jules Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA. aldave@jsei.ucla.edu
Anthony J
AJ
Aldave
Elmira
E
Baghdasaryan
Kevin M
KM
Miller
D000328:Adult; D000368:Aged; D015715:Corneal Edema / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D006084:Graft Rejection / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D007499:Iris Diseases / Q000534:rehabilitation*; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D011474:Prosthesis Design; D012189:Retrospective Studies; D012599:Sclerostomy; D013524:Surgical Flaps; D014792:Visual Acuity / Q000502:physiology