Phakic descemet stripping automated endothelial keratoplasty: prevalence and prognostic impact of postoperative cataracts.

PURPOSE

To determine the prevalence and risk factors for the development of visually significant cataracts after phakic Descemet stripping automated endothelial keratoplasty (DSAEK) and the impact of this complication on the final outcome.

METHODS

A retrospective case review was conducted of 12 consecutive eyes with corneal decompensation secondary to Fuchs endothelial dystrophy that had been treated with DSAEK without concomitant removal of the crystalline lens from January 1, 2005 to July 1, 2007 at the University of Iowa Hospitals and Clinics. Eyes in which a minimum follow-up period of 12 months was available were included in the statistical analysis.

RESULTS

Of the 10 eyes that met the inclusion criteria, visually significant cataracts occurred in 4 eyes (40%) in the first postoperative year and required surgical intervention. A significant difference in the mean anterior chamber depth was detected between eyes that developed cataracts and those that did not (P = 0.005). In 3 eyes, cataract development was associated with a preoperative anterior chamber depth of less than 2.80 mm. All 3 of these eyes developed pupillary block with markedly elevated intraocular pressure during the first 24 postoperative hours. After 24 months, the 6 eyes that did not develop cataracts had a mean best spectacle-corrected visual acuity of 20/24. Among the 4 eyes that required cataract surgery, the mean best spectacle-corrected visual acuity was 20/35. One eye had developed endothelial graft failure and required repeat DSAEK.

CONCLUSIONS

The development of cataracts is common after phakic DSAEK and may be associated with considerable ocular morbidity.