Objective To evaluate triple procedure of combined Descemet’s stripping automated endothelial keratoplasty (DSAEK), phacoemulsification, and intraocular lens (IOL) implantation for patients with Fuchs endothelial dystrophy and cataract in shallow anterior chamber.
Methods Retrospective cohort study of 31 eyes in 26 consecutive patients with corneal edema from Fuchs endothelial dystrophy. Sixteen eyes with cataract underwent triple procedure as group A. Fifteen pseudophakic eyes underwent single DSAEK as group B. Best corrected visual acuity (BCVA), central corneal thickness (CCT), anterior chamber depth (ACD), and endothelial cell density (ECD) were measured and compared preoperatively and 6 months postoperatively. Intraoperative difficulty and postoperative complications were recorded as surgical events. The odds ratio (OR) with 95% confidence intervals (95% CI) was determined for risk factors of events.
Results There was similar BCVA improvement between groups (P=0.000). Average ECD was 1737±507/mm2 (39% cell loss) in group A, and significantly less than 2109±399/mm2 (30% cell loss) in group B (P=0.036). Between group A and B, the occurrence of events were 8/16 versus 2/15 (P=0.054), of intraoperative difficulty were 6/16 versus 0/15 (P=0.000), and of postoperative complications were 4/16 versus 2/15 (P=0.654). Risk factors for adverse events were floppy iris syndrome (P=0.007: OR,14.25; 95% CI,2.1-98), and CCT> 880μm plus ACD<1.30mm (P=0.020; OR,9.5; 95% CI,1.4-64). In group A, eyes with those factors had less postoperative ECD (P=0.001), while those without risk factors had similar occurrence of events (P=0.435) and postoperative ECD (P=0.983) to eyes in group B.
Conclusions Triple procedure of DSAEK can be successfully performed for Fuchs endothelial dystrophy and cataract in shallow anterior chamber with satisfactory results. It is surgically challenging in this case, and should not be performed when floppy iris syndrome were likely, or severe corneal edema (CCT< 880μm plus extremely shallow anterior chamber (ACD<1.30mm). |
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