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Intraocular lens opacification after Descemet's stripping automated endothelial keratoplasty (DSAEK)

Poster Details

First Author: P.Morgan-Warren UK

Co Author(s):    A. Patel              

Abstract Details



Purpose:

Descemet stripping automated endothelial keratoplasty (DSAEK) has rapidly become the surgical procedure of choice over the last decade for corneal decompensation due to endothelial dysfunction. It is only recently, however, that opacification of hydrophilic acrylic intraocular lenses (IOLs) as a late complication of DSAEK in pseudophakic patients has been reported in the literature. We present five cases from our practice which may help to provide a greater understanding of the development of IOL opacification in these patients.

Setting:

Department of Ophthalmology, Solihull Hospital, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.

Methods:

In this retrospective case series, we identified patients from corneal clinic records with IOL opacification who had previously undergone DSAEK surgery and reviewed the clinical details.

Results:

Five patients (3 male, 2 female) were identified who have developed IOL opacification after DSAEK surgery, with average age 75.8 years (range 71-81). All patients underwent DSAEK for corneal decompensation secondary to Fuchs' endothelial dystrophy and had received hydrophilic acrylic IOL models during their prior cataract surgery, including 4 with Softec 1 (Lenstec UK, Wakefield, UK) and 1 with 570c (Rayner Intraocular Lenses Ltd, Hove, UK). All patients developed a central crystalline opacification on the anterior aspect of the IOL, occurring between 5 months and up to 6 years after DSAEK surgery. Four patients (80%) had required re-bubbling with intracameral injection of air for partial dislocation of donor graft tissue within the first post-operative week. The patient who did not require re-bubbling had experienced an intraocular pressure (IOP) spike on the first post-operative day which required medical intervention. One patient is currently awaiting IOL exchange, whilst the remainder are under conservative management.

Conclusions:

We report five cases of late-onset IOL opacification in patients after DSAEK surgery. Repeated exposure to intracameral air in the post-operative period may be a major aetiological factor, although raised IOP and other factors may also contribute. IOL opacification in these patients is associated exclusively with hydrophilic acrylic IOLs, and therefore we advise avoiding such lenses in patients who are at risk of developing corneal decompensation that would require subsequent endothelial keratoplasty. FINANCIAL INTEREST: NONE

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