Clinical results of triple Descemet's stripping and automated endothelial keratoplasty (DSAEK)

PurposeTo evaluate visual acuity (VA), refractive outcome, endothelial cell loss rate and complications of Descemet's stripping and automated endothelial keratoplasty (DSAEK) combined with phacoemulsification and intraocular lens (IOL) implantation in patients with coexisting corneal endothelial dysfunction and cataracts.MethodsSeventeen patients underwent phacoemulsification and posterior chamber IOL implantationthrough temporal corneal incision, followed by DSAEK. The selection of IOL power was predicted by preoperative lens power calculations of fellow eye plus 0.5 to 1.0 diopters (D).ResultsThere were five cases of laser iridotomy induced corneal dysfunction, four cases of Fuch's dystrophy, three cases of cytomegalovirus (CMV) endotheliitis, three cases of iridocorneal endothelial (ICE) syndrome, one case of herpes simplex virus (HSV) endotheliitis, and one case with an unknown cause. The BSCVAs were all under 0.2 preoperatively, and the average BSCVA was 0.3 postoperatively. The postoperative spherical equivalent (SE) refractive error was −0.11 D on an average. The endothelial cell loss rate was −36.86% at 6 months and −38.60% at 12 months. There was one case of graft rejection at 6 months, and one case of primary graft failure. Complications such as donor detachment, pupillary block, donor graft folds, epithelial ingrowth, or interface scar did not occur.ConclusionThis case series of DSAEK combined with phacoemulsification and IOL implantation suggests that the procedure provides rapid visual rehabilitation and allows the selection of an appropriate IOL.