New Triple Procedure: Descemet’s Stripping and Automated Endothelial Keratoplasty Combined with Phacoemulsification and Intraocular Lens Implantation

Abstract

To evaluate visual acuity (VA), graft clarity, and refractive outcome of Descemet's stripping and automated endothelial keratoplasty (DSAEK) combined with phacoemulsification and intraocular lens (IOL) implantation in patients with coexisting Fuchs' endothelial dystrophy and immature senile cataracts. Pilot, prospective, noncomparative, surgical case series. Twenty-one eyes of 21 consecutive patients with coexisting visually significant immature senile cataracts and Fuchs' corneal dystrophy with guttata of Descemet's membrane and either microcystic epithelial edema or stromal edema presenting to a single academic eye institute. All patients underwent phacoemulsification and posterior chamber IOL implantation through temporal clear corneal incision, followed by DSAEK. The intent was to render all eyes as close to emmetropia as possible. Six-month postoperative best spectacle-corrected VA (BSCVA), refractive spherical equivalent (SE), refractive astigmatism, and keratometry. Average BSCVAs were 20/68 preoperatively and 20/34 postoperatively (P<0.0001). The postoperative SE refractive error was +0.45 diopters (D), on average +1.13 D more hyperopic than predicted by preoperative lens power calculations. Overall, 13 patients (62%) were within 1.00 D and 21 (100%) were within 2.00 D of emmetropia postoperatively. Preoperative and postoperative average refractive astigmatisms were 1.46 D and 1.56 D, respectively (P = 0.69). Complications included graft dislocations requiring repositioning (3), 2 of which experienced recurrent dislocation requiring reoperation with a new graft; acute graft rejection (3); and pupillary block glaucoma (2). This pilot case series of 6-month results of DSAEK combined with phacoemulsification and IOL implantation suggests that it provides rapid visual rehabilitation with predictable refractive outcomes.