Descemet Stripping Automated Endothelial Keratoplasty for Bullous Keratopathy After Anterior–Posterior Radial Keratotomy

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Abstract

Purpose:

To report the outcome of Descemet stripping automated endothelial keratoplasty (DSAEK) for bullous keratopathy after Sato anterior–posterior radial keratotomy (APRK).

Methods:

The clinical records of patients who had DSAEK surgery for bullous keratopathy after APRK were reviewed.

Results:

Five eyes of 4 patients (4 men) were included. The mean age at DSAEK surgery was 81.8 ± 7.1 years (range, 73–90 years), and the mean follow-up period after the surgery was 19.8 ± 16.9 months (range, 6–48 months). The mean preoperative logarithm of the minimum angle of resolution–corrected visual acuity was 1.96 ± 0.50 (range, 1.2 to counting fingers), and this improved to 0.49 ± 0.43 (range, 0.05–1.2) at the final follow-up. The mean preoperative donor cornea central endothelial cell density was 2826.0 ± 335.7 cells per square millimeter (range, 2352–3150 cells/mm2), and this declined to 863.5 ± 501.7 cells per square millimeter (range, 500–1255 cells/mm2) at the final follow-up, a mean reduction of 68.2%. The mean graft size was 8.2 ± 0.21 mm (range, 8.0–8.5 mm). Postoperative complications included early graft dislocation in 3 eyes (60.0%), with successful repositioning by a single rebubbling in all cases. There was no graft rejection, and no patient required repeat DSAEK or penetrating keratoplasty for graft failure.

Conclusions:

This small series suggests that DSAEK is an effective surgical option after APRK. Although there was a high rate of graft dislocation, this was successfully managed by rebubbling. Subsequently, the attachment of each graft improved gradually over time. DSAEK seems to be a reasonable alternative to penetrating keratoplasty for patients with bullous keratopathy after APRK.

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