title: Viscoelastic-Assisted Non-Descemet Stripping Automated Endothelial Keratoplasty in Vitrectomized and Iris-Lens Diaphragm Injured Eyes.
abstract: OBJECTIVE
  To report the outcomes of viscoelastic-aided non-Descemet stripping automated endothelial keratoplasty (nDSAEK) to treat bullous keratopathy in vitrectomized and iris-lens diaphragm injured eyes.
  
  
  METHODS
  A prospective consecutive case series of eyes with bullous keratopathy underwent nDSAEK. About 0.15 to 0.2 mL cohesive viscoelastic was injected into the anterior chamber in front of the iris defect to prevent air from entering the posterior chamber and vitreous cavity. Filtered air was injected until the intraocular pressure (IOP) rose to a mildly high level. Graft position and complications were monitored postoperatively. Endothelial cell density and best-corrected visual acuity (BCVA) were recorded at a 1-year follow-up.
  
  
  RESULTS
  Viscoelastic-aided nDSAEK was performed in 21 cases (11 males, 10 females; mean age: 58.9±12.4 years). No intraoperative complications were noted. Effective graft adherence was achieved in all cases intraoperatively. Postoperatively, partial graft dislocation was seen in 2 cases because of hypotony (IOP, 6 and 5 mm Hg, respectively) due to postoperative cyclodialysis as demonstrated on anterior segment optical coherence tomography. Hypotony was successfully managed conservatively with spontaneous graft reattachment. One year postoperatively, the median BCVA improved to 20/50. The mean endothelial cell loss was 14.7±12.6% and 20.5±11.1% at 6 months and 1 year, respectively.
  
  
  CONCLUSIONS
  In vitrectomized and iris-lens diaphragm injured eyes, viscoelastic-aided nDSAEK effectively facilitated graft adherence and reduced graft dislocation. Appropriate control of IOP was considered to play a vital role in supporting the graft adherence.
authors.affiliation: School of Ophthalmology and Optometry and Eye Hospital (Y.R., Z.Z., Y.S., W.C.), Wenzhou Medical University, Zhejiang, China; Department of Surgery (S.G.W.), Uniformed Services University of Health Sciences, Bethesda, MD; and Department of Ophthalmology and Vision Science (V.J.), the Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Yueping
authors.initials: Y
authors.lastname: Ren
authors.forename: Zelin
authors.initials: Z
authors.lastname: Zhao
authors.forename: Yumei
authors.initials: Y
authors.lastname: Shao
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Waller
authors.forename: Vishal
authors.initials: V
authors.lastname: Jhanji
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
mesh_terms: D000368:Aged; D000867:Anterior Chamber / Q000601:surgery; D003316:Corneal Diseases / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D056965:Injections, Intraocular; D007498:Iris / Q000293:injuries; D007908:Lens, Crystalline / Q000293:injuries; D008297:Male; D008875:Middle Aged; D041623:Tomography, Optical Coherence; D055682:Viscoelastic Substances / Q000008:administration & dosage*; D014821:Vitrectomy / Q000009:adverse effects
chemical_list: D055682:Viscoelastic Substances