Descemet Stripping Automated Endothelial Keratoplasty in the Phakic Eye

Abstract

To evaluate the visual acuity, graft clarity, refractive outcome, and crystalline lens clarity in phakic patients undergoing Descemet stripping automated endothelial keratoplasty (DSAEK). Six eyes of 4 consecutive patients with clear crystalline lenses and corneal edema because of either Fuchs dystrophy (4 eyes) or amantadine-induced corneal endothelial toxicity (2 eyes) were included in this study. All patients underwent simple DSAEK using a 4.2-mm temporal clear corneal incision. The 8.5-mm donor lenticule was folded and inserted into the anterior chamber using an Utrata forceps. A 10-minute air bubble tamponade was used. Best-corrected spectacle visual acuity, refractive error, graft status, and crystalline lens clarity were measured at a minimum of 6 months postoperatively. All grafts for Fuchs dystrophy remained clear, whereas 2 grafts failed because of continued amantadine corneal toxicity. Excluding the failed grafts, the average preoperative best-corrected spectacle visual acuity was 20/47 compared with 20/28 postoperatively (P = 0.0024). There were no intraoperative complications, and no eyes developed pupillary block glaucoma or cataracts during an average follow-up interval of 9.1 months (6-14 months). DSAEK may be safely performed in the phakic eye.