title: Comparison of ACIOL Retention With IOL Exchange in Patients Undergoing Descemet Stripping Automated Endothelial Keratoplasty.
abstract: OBJECTIVE
  To investigate clinical outcomes in the management of anterior chamber intraocular lenses (ACIOLs) in patients requiring Descemet stripping automated endothelial keratoplasty (DSAEK) for pseudophakic corneal edema.
  
  
  METHODS
  This is a retrospective review of DSAEK procedures performed at a single center between May 1, 2006, and August 1, 2014.
  
  
  RESULTS
  Forty-three eyes (41 patients) with pseudophakic corneal edema and an ACIOL were identified. In 26 eyes (60.5%), the ACIOL was retained [intraocular lens retention (IOLR) group], and in 17 eyes (39.5%), intraocular lens exchange [(IOLX) group] was concurrent with DSAEK. No significant difference was noted between the IOLR and IOLX groups for the following: the incidence of primary graft failure (7.7% vs. 5.9%; P = 1.0); the incidence (3.8% vs. 0.0%; P = 1.0) or rate (0.036 per eye-year vs. 0 per eye-year; P = 0.28) of secondary graft failure; or the incidence (7.7% vs. 11.8%; P = 1.0) or rate (0.056 per eye-year vs. 0.073 per eye-year; P = 0.69) of endothelial rejection. However, the incidence (23.1% vs. 58.8%; P = 0.026) and rate (0.291 per eye-year vs. 0.475 per eye-year; P = 0.033) of increased intraocular pressure were significantly higher in the IOLX group. There were more complications in the IOLX group, although the difference was not significant (7.7% vs. 29.4%; P = 0.093).
  
  
  CONCLUSIONS
  There is no significant difference in the incidence of primary graft failure or in the rate of secondary graft failure or endothelial rejection in eyes with ACIOL retention or exchange. However, as IOLX is associated with intraoperative and postoperative complications and an increased rate of postoperative intraocular pressure elevation, we recommend performing DSAEK with retention of well-positioned ACIOLs in these eyes.
authors.affiliation: The Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Anjali
authors.initials: A
authors.lastname: Tannan
authors.forename: Rosalind C
authors.initials: RC
authors.lastname: Vo
authors.forename: Judy L
authors.initials: JL
authors.lastname: Chen
authors.forename: Fei
authors.initials: F
authors.lastname: Yu
authors.forename: Sophie X
authors.initials: SX
authors.lastname: Deng
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Aldave
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber; D015715:Corneal Edema / Q000503:physiopathology / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D006085:Graft Survival; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D019591:Pseudophakia / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology