Descemet Stripping Automated Endothelial Keratoplasty for Endothelial Decompensation in Buphthalmos

Abstract

To report the results of Descemet stripping automated endothelial keratoplasty (DSAEK) to treat endothelial failure in eyes with buphthalmos. Prospective interventional case series. All buphthalmic eyes with endothelial failure undergoing DSAEK by the same surgeon (M.B.) between March 2007 and January 2012 were included. Outcome measures included best spectacle-corrected visual acuity (BSCVA), refraction, and endothelial cell loss (assessed 6, 12, 24, 36, and 48 months postoperatively). Standardized DSAEK was performed in all cases, with minor modifications in phakic and aphakic eyes. Other outcomes included comparisons to penetrating keratoplasty (PK) published results and comparisons to visual outcomes in DSAEK for other indications. There were 14 transplants performed in 12 eyes (11 patients). Mean age was 34.9 years (range 15-54 years). The average follow-up was 21.7 ± 13.8 months (range 6-48 months). At last follow-up examination, BSCVA had improved in 11 of 13 cases, with a logMAR average value ± standard deviation of 0.74 ± 0.66 from the preoperative value of 2.07 ± 0.80. Eleven eyes reached Snellen acuity of 20/200 or better, and 5 eyes reached 20/40 or better. Mean endothelial cell loss was 40.5% ± 8.9% (range 23.7%-53.1%). Complications included graft detachment (n = 2), glaucoma progression (n = 1), and late endothelial failure (n = 1). All complications were managed successfully either by repeat DSAEK (n = 2), rebubbling (n = 1), or cyclocryocoagulation (n = 1). DSAEK may be performed safely and effectively in buphthalmic eyes, with comparable results to outcomes after PK. Visual outcomes are not substantially different after DSAEK for this indication compared to DSAEK for other indications.