Outcomes Of Endothelial Keratoplasty Following Scleral-Fixated Intraocular Lens Implantation
Published 2025 - 43rd Congress of the ESCRS
Reference: PO511 | Type: Free paper | DOI: 10.82333/9psw-9q02
Authors: Damien Gatinel* 1 , Jacques Malet 2
1Rothschild Foundation Hospital,Paris,France;Abulcasis International University of Health Sciences,Rabat,Morocco, 2Rothschild Foundation Hospital,Paris,France
Purpose
To assess the clinical outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) and Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in patients who previously underwent Scleral-Fixated Intraocular Lens (SFIOL) implantation.
Setting
A retrospective study conducted at a tertiary ophthalmic centre, Moorfields Eye Hospital NHS Trust.
Methods
Patients who underwent SFIOL implantation followed by endothelial keratoplasty (EK) between January 1, 2016, and December 31, 2024, were identified from electronic patient records. Data collected included patient demographics, past ocular history, details of SFIOL and EK surgery (including complications), need for re-bubbling, LogMAR distance visual acuity (DVA) and graft survival.
Results
20 patients identified: median age 69 (range 41-90), 6 female:14 male. Pre-op risk factors for graft failure: 5 had prior corneal grafts, 6 had glaucoma (3 with prior trabeculectomy/tube). Mean number of surgeries prior to EK was 2.90 ± 1.21. Cases: 35% by Consultant, 65% by Fellow, with 6 DMEKs and 14 DSAEKs. There were no surgical complications, but 10% had graft unfolding difficulty. Mean follow up was 28.29 months (range 0.79-68.61). 25% required re-bubbling. Mean LogMAR DVA improved from 1.26 ± 0.53 to 0.54 ± 0.45 at 2 years. 25% of grafts failed: 1 primary, 4 endothelial (mean time to failure 13.38 ± 10.89 months). Increased risk of failure was associated with grade of surgeon (Fellow), older age of patient, and prior graft failure.
Conclusions
There is a paucity of data in the literature on endothelial keratoplasty outcomes in patients with prior SFIOL implantation. This relatively complex cohort of patients typically have several ocular co-morbidities and have undergone multiple prior surgeries which can negatively affect graft survival. Our data demonstrates that graft surgery improves vision by an average of 7 lines at 2 years in this cohort, but that there is a higher risk of re-bubbling and graft failure compared to data available on all EKs.