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Cystoid macular edema after Descemet's stripping automated endothelial keratoplasty (DSAEK): incidence after combined procedure compared to DSAEK alone

Poster Details

First Author: T.Salvador PlayĆ  SPAIN

Co Author(s):    E. Pedemonte-Sarrias   I. Sassot Cladera   N. Gimenez        

Abstract Details



Purpose:

To determine the incidence of cystoid macular edema (CME) after Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) combined with phacoemulsification and to compare it to the incidence after DSAEK alone

Setting:

The study was performed at a terciary cornea reference hospital. All patients were operated by two cornea surgeons using the same standard technique between 2008 and 2012

Methods:

We screened all posterior chamber (PC) pseudophakic patients who had undergone DSAEK surgery; as well as all phakic patients who had undergone DSAEK concurrent with cataract surgery. Exclusion criteria were: previous intraocular surgery other than phacoemulsification with PC intraocular lens (IOL) implantation, prior keratoplasty and previous history of ocular trauma, uveitis, congenital glaucoma and/or macular cystoid edema. Macular pathology was screened biomicroscopically before surgery, when possible. The 55 eyes -from 47 patients- which matched the selection criteria were reviewed retrospectively. Fourteen eyes had been operated of DSAEK combined with phacoemulsification. 41 were PC pseudophakic eyes operated of DSAEK alone. CME was diagnosed clinically at the slit-lamp and confirmed by optical coherence tomography. Both groups were statistically compared.

Results:

Three cases of CME were diagnosed postoperatively in each group, which represent 21% after DSAEK combined with cataract surgery and 7% after DSAEK alone. None of the eyes which had received prophylaxis developed CME. Considering only the eyes with no prophylaxis, the incidence was of 30% after DSAEK concurrent with cataract surgery and 8% after DSAEK alone. Five out of six patients responded to classical therapy against CME.

Conclusions:

CME is a possible complication after DSAEK and appears more frequently than following modern cataract surgery. It is more frequent when DSAEK is combined with phacoemulsification and PC IOL implantation. When present, it can be treated with classical therapy. Until the causes remain unclear, we recommend administering prophylaxis when risk factors are present or when combined surgery is done. These conclusions might be extensible to other lamellar endothelial keratoplasties, such Descemet's Stripping Endothelial Keratoplasty (DSEK) or Descemet's Membrane Endothelial Keratoplasty (DMEK). FINANCIAL INTEREST: NONE

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