Évaluation pratique de la prise en charge par DSAEK des décompensations endothéliales après kératoplasties transfixiantes

Abstract

To report our anatomical and functional results as well as possible complications of the first six Descemet's stripping endothelial keratoplasties (DSAEK) performed in our department for endothelial decompensation after penetrating keratoplasty (PK) METHODS: This was a retrospective and observational monocentric study of six patients with DSAEK after prior PK between January 2015and July 2016. The data collected were: demographic characteristics (age, sex), ophthalmological comorbidities, initial indication for PK, delay between PK and DSAEK. Best corrected visual acuity (BCVA) preoperatively and at 1, 3and 6months postoperatively were collected in Monoyer's and Parinaud scale and converted to log MAR for statistical analysis. The central cornea and graft thickness measured on OCT as well as postoperative complications were also collected. Mean follow-up duration was 7.2months [3-10]. The average time after PK was 7.7years. The mean age of the patients was 67.5years [32-87]. The initial indication for PK was Fuchs dystrophy (3/6), pseudophakic bullous keratopathy (1/6), corneal laceration (1/6) and other corneal dystrophy (1/6). The authors report one case a combined phaco-DSAEK surgery. The complications observed were: an early graft detachment treated by an additional air bubble injection (1/6) and cystoid macular edema in one other case. The average central corneal thickness decreased from 780μm at day7postoperatively to 656μm at 6months. The average thickness of the graft decreased from 154μm at day7to 122μm at 6months. The mean preoperative BCVA was 1.52log MAR [1.0-1.7], compared to the mean postoperative BCVA which was 1.5log MAR [1.1-2.3] at 1month, 1.15log MAR [0.5-1.7] at 3months and 1.1log MAR [0.7-1.7] at 6months (data available for 4patients at 6months). The recovery of visual acuity was limited in 2cases, despite corneal clarity restored in all our patients. Our results can be compared to those described in literature. As more penetrating keratoplasty grafts reach the end of their lives, this will allow for more powerful studies. DSAEK on eyes previously treated with PK is a good alternative to a new PK in the case of endothelial decompensation of the graft. The possibility of a posterior lamellar graft allows for faster visual recovery, with preservation of the anterior corneal power and a lower rate of complications.