Descemet stripping automated endothelial keratoplasty with intrascleral haptic fixed IOL: simultaneous versus sequential
First Author: R.Sinha INDIA
Co Author(s): H. Rubsingh N. Sharma T. Agarwal S. Nair J. Titiyal
Descemet stripping automated endothelial keratoplasty (DSAEK) with intrascleral haptic fixed IOL in a combined and sequential approach.
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
Aphakic or pseudophakic bullous keratopathy patients visiting a tertiary eye care centre were included in the study. A total of 40 patients were randomized into two groups of 20 each. Group 1 had subjects who underwent scleral fixated intraocular lens implantataion (SFIOL) followed by DSAEK (sequential procedure) with an interval of 3 months. Group 2 had subjects who underwent DSAEK with SFIOL as combined procedure (simultaneous). Best spectacle corrected visual acuity (BCVA) , graft survival, endothelial cell loss and need for any reintervention like rebubbling were evaluated for both the groups at the end of 3 months.
At 3 months follow up, the sequential group had significantly better BSCVA of 0.62±0.17 logarithm of the minimum angle of resolution (logMAR) compared with 0.87±0.19 logMAR in simultaneous group (P = 0.002). The sequential group had significantly better overall cumulative graft survival than simultaneous group (100% versus 60%, P = 0.002). The simultaneous group had significantly higher endothelial cell loss (29.6%) than the sequential group (25.4%) (P=0.019). Rebubbling rate was significantly higher in simultaneous group as compared with sequential group (60% versus 25%, P=0.025).
The sequential procedure of SFIOL followed by DSAEK has better visual outcomes and graft survival as compared with simultaneous procedure in cases of aphakic or pseudophakic bullous keratopathy.