Descemet’s Stripping with Endothelial Keratoplasty for Special Fuchs’ Endothelial Dystrophy in Phakic Eyes

Abstract

Background: To determine the efficacy and postoperative complications of simple Descemet’s stripping endothelial keratoplasty (DSEK) for treatment of special Fuchs’ endothelial dystrophy in phakic eyes. Methods: Six eyes with clear crystalline lenses in 5 consecutive patients with Fuchs’ endothelial dystrophy underwent DSEK and were followed up for 12–27 months. The pupil was constricted preoperatively to 1.5 mm in diameter. The anterior chamber was deepened intraoperatively by injection of balanced salt solution to unfold the donor graft and to protect the crystalline lens. Best corrected visual acuity, corneal astigmatism, corneal curvature, corneal thickness, and anterior chamber depth were recorded preoperatively and at 6 and 12 months postoperatively. Average endothelial cell density and endothelial cell loss (ECL) were recorded at 6 and 12 months postoperatively. Results: DSEK was successfully performed in all 6 eyes. No graft dislocation or lens injury occurred. One of the 6 eyes presented with mild cataract at 12 months after surgery but showed no sign of progressive cataract development during the follow-up. All grafts were clear during the last follow-up: best corrected visual acuity ranged from 20/50 to 20/30, average corneal astigmatism was 2.2 ± 0.6 dpt, average corneal curvature was 46.0 ± 2.4 dpt, and average central corneal thickness was 583.0 ± 21.5 µm. At 6 and 12 months postoperatively, average endothelial cell density was 2,070.7 ± 206.1 cells/mm² (28.0 ± 7.5% of ECL) and 1,838.3 ± 194.5 cells/mm² (36.1 ± 6.2% of ECL), respectively. Conclusions: Simple DSEK might be a feasible option for Fuchs’ endothelial dystrophy in young patients with clear crystalline lenses.