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First Author: T.Chowdhury INDIA
Co Author(s): A. Mohanta
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To assess the outcome of manual DSEK in presence of an AC IOL or iris-claw lenses and to evaluate the maintenance of graft clarity with donor endothelial cell loss in 2 years after manual DSEK which was done for donor endothelial decompensation leading to pseudophakic bullous keratopathy.
Disha Eye Hospitals, Kolkata, India.
We did a retrospective, non-comparative interventional case study for 17 eyes who underwent manual DSEK with retained AC IOL or iris-claw lenses.Cases with central AC depth < 3 mm and vitreous in Ac were excluded from the study. All cases underwent pre-operative UBM to rule out any angle closure or peripheral anterior synechia. Donor with endothelial cell density (ECD) >2800 cells/sq mm were used.Follow-up ranged from 24 to 33 months. The donor ECD at 6,12 and 24 months post-operatively were measured and compared with preoperative ECD.
In the immediate post-operative period 3 eyes had donor dislocation which needed rebubbling with air of which one graft ultimately got failed. Out of remaining 14 eyes, 13 eyes maintained good graft clarity and one eye had primary graft failure.The mean ECD at 6th month post-operative visit was 1952 cells/sq mm, at 12 th month post-operative visit was 1705 cells/sq mm and at 24th month post-operative visit was 1543 cells/sq mm. There was no significant difference in cell loss in our small series compared with ECD loss in DSEK with presence of PC IOL.
Manual DSEK in the presence of a properly centred ACIOL or iris-claw lenses can be a good option for old patients who are not willing for 2 stage procedure and for patients who had initial good vision following cataract surgery. To maximize the graft survival,the surgery should be done with minimum tissue manipulation and the donor edge should be free from IOL margin