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Descemet's stripping automated endothelial keratoplasty with scleral fixated intraocular lens: a comparison of sequential versus simultaneous approach

Poster Details

First Author: H.R INDIA

Co Author(s):    R. Sinha                    

Abstract Details


To compare the outcomes in Descemet Stripping Automated Endothelial Keratoplasty with Scleral Fixated IOL in simultaneous and sequential approach.


Tertiary eye care Centre, Dr R P Centre, AIIMS, New Delhi


Forty patients with bullous keratopathy with aphakia or complicated pseudophakia were included and were randomized into two groups of twenty each.Group one underwent SFIOL followed by DSAEK (sequential procedure) with an interval of at least 3 months. Group two had twenty subjects who underwent DSAEK with SFIOL as combined procedure (simultaneous approach).Best corrected visual acuity,central corneal thickness,donor lenticule thickness,endothelial cell loss and need for any re-intervention like rebubbling were recorded at postoperative day one,day seven,one month and three months.


At three months follow up,the sequential group had significantly better best corrected visual acuity than the simultaneous group(0.62±0.17 logMAR versus 0.87±0.19 logMAR,P = 0.002).The overall cumulative graft survival was better in the simultaneous group(100% versus 60%,P = 0.002).Endothelial cell loss was higher in the simultaneous group (29.6%) than the sequential group (25.4%) (P=0.019).Lenticule detachment was more in simultaneous group as compared with sequential group (60% versus 25%, P=0.025).The mean central corneal thickness was lesser in the simultaneous group (565.9±25.4 µm versus 606.2±66µm,P=0.03).Donor lenticule thickness was lesser in the sequential group (90.7±13µm versus 101.1±9.5µm,P=0.009).


From our study we observe that sequential approach has better visual outcome,lesser endothelial cell loss,better lenticule attachment,higher graft survival,lesser central corneal and donor lenticule thickness.In simultaneous approach the donor lenticule is subjected to more intraoperative manipulation leading to poor graft survival.

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