Descemet membrane endothelial keratoplasty for corneal decompensation caused by a phakic anterior chamber intraocular le
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CORNEA
Descemet membrane endothelial keratoplasty for corneal decompensation caused by a phakic anterior chamber intraocular lens implantation Ting Huang 1 & Jing Wu 1 & Xiaojuan Dong 1 & Jianping Ji 1 & Chen Ouyang 1 & Lijie Xie 1 & Chao Hou 1 Received: 27 June 2020 / Revised: 5 September 2020 / Accepted: 10 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To describe the clinical outcomes of Descemet membrane endothelial keratoplasty combined with phacoemulsification/ posterior chamber intraocular lens implantation (triple procedure) for treatment of corneal decompensation induced by a phakic anterior chamber intraocular lens (AC IOL) implantation. Methods Ten patients (10 eyes) with corneal decompensation due to phakic AC IOL implantation that had undergone the triple procedure were included in this study. Among the 10 eyes, 5 eyes underwent explantation of AC IOL prior to the transplantation, and then underwent the triple procedure. The remaining 5 eyes with a phakic AC IOL in situ underwent the triple procedure with concurrent explantation of AC IOL. Corrected distance visual acuity (CDVA), subjective refraction, endothelial cell density (ECD), and complications were documented. Results The triple procedure was performed across all eyes without any adverse events. The average CDVA improved from 1.32 ± 0.24 preoperatively to 0.15 ± 0.05 logarithm of the minimum angle of resolution (logMAR), which represents an improvement in Snellen equivalent from 20/400 (0.05) preoperatively to 20/28 (0.71) at 12 months after surgery. At 12 months, all eyes reached a CDVA of 20/32 (0.63) or better, and 50% of eyes reached a CDVA of 20/25 (0.8) or better. The mean donor ECD±SD was 2868.7 ± 67.9 cells/mm2, which decreased to 1724.1 ± 84.6 cells/mm2 at 12 months, representing 39.9% of endothelial cell loss. Patients did not experience any severe adverse events. Conclusion The triple procedure is a safe and effective option for corneal decompensation induced by a phakic AC IOL implantation, helping achieve a satisfactory visual rehabilitation with few complications. Keywords Descemet membrane endothelial keratoplasty . Anterior chamber intraocular lens . Corneal decompensation
Introduction A phakic anterior chamber intraocular lens (AC IOL) implantation has emerged as an effective option for refractive surgery [1–4]. Unfortunately, this novel approach is now facing extreme challenges due to a series of adverse events [5–9]. Among them, the main concern is endothelial cell loss. In general, refractive outcomes are excellent with few complications. However, patients may still develop corneal decompensation after implantation [10–12].
* Ting Huang [email protected] 1
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
In the event of corneal decompensation, definitive management involves explantation of an AC IOL and surgical transplantation of corneal tissue [10–14]. However, this complication usually occurs in relativ
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