Descemet Stripping Automated Endothelial Keratoplasty for Bullous Keratopathy With an Irregular Posterior Surface

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To investigate the efficacy and safety of Descemet stripping automated endothelial keratoplasty (DSAEK) for bullous keratopathy with an irregular posterior surface of the cornea caused by anterior–posterior radial keratotomy or forceps injury. The results were compared with eyes that had undergone penetrating keratoplasty (PKP).


Six eyes of 6 Japanese patients (mean age, 52.0 years) who underwent DSAEK between 2007 and 2012 were analyzed retrospectively. Of the 6 cases, 5 were birth injuries and 1 resulted from anterior–posterior keratotomy. Five of the 6 cases had mild-to-moderate amblyopia. The clinical results of DSAEK were compared with the outcomes of disease-matched cases treated with PKP [19 eyes of 18 patients (mean age, 58.4 years): 9 cases were birth injuries and 10 resulted from anterior–posterior keratotomy]. Subjective symptoms, graft clarity, best-corrected visual acuity, corneal astigmatism, postoperative endothelial cell density, posterior irregularity, and intraoperative and postoperative complications were evaluated.


All grafts were attached successfully without double chamber formation following DSAEK. The corneas remained clear throughout the observation period, and the subjective symptoms improved in all cases. Significant improvement was observed in the best spectacle–corrected visual acuity and posterior irregularity in all the patients. No significant difference in corneal astigmatism was observed between the DSAEK and PKP groups. The mean endothelial cell density was 1450 cells per square millimeter 6 months postoperatively in the DSAEK group, which was similar to that in the PKP group.


DSAEK is considered to be useful, even in bullous keratopathy eyes with an irregular posterior surface.

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