DSAEK and Fuchs Endothelial Dystrophy - A Retrospective Study: Comparing DSAEK and DSAEK Combined with Cataract Surgery

Abstract

Objective/Purpose: The authors present a retrospective study of 30 eyes of 26 patients with Fuchs dystrophy treated with Descemet Stripping Automated Endothelial Keratoplasty and compare its association with cataract surgery. Fuchs dystrophy is a hereditary endothelial disease characterized by a progressive loss of endothelial cells that leads to polymegathism and pleiomorphism with corneal edema. Fuchs endothelial dystrophy is one of the most common indications for DSAEK. The surgical procedure consists of two main steps: stripping of endothelium and Descemet’s membrane from the recipient and attaching the donor tissue using air tamponade.
Materials/Patients: 30 eyes of 26 patients with Fuchs dystrophy followed in the cornea department outpatient clinic that were submitted to DSAEK and DSAEK combined with cataract surgery by the same surgical team.
Methods: A throughout analysis of indications and pre-operative and postoperative visual acuity (VA) was performed. A comparison between the results of DSAEK procedure and DSAEK combined with phacoemulsification and posterior chamber lens implantation was also done. The safety and efficacy of the procedure was studied. Anterior chamber OCT and videokeratography was obtained in some patients.
Results: The patients mean age was 67±10.42 years and 62.9% were women. The DSAEK procedure was combined with phacoemulsification and posterior chamber IOL implantation in 38.5% of the cases. Preoperative average best-corrected VA was 0,26±0,16 and best-corrected postoperative average VA was 0,60±0,24. The mean average VA increase was 0,34±0,25. With the combined procedure the preoperative, postoperative best VA and VA increase were higher but the differences weren’t statistically significant (0.29±0.15, 0.66±0.28, 0.38±0.23 vs 0.24±0.17, 0.57±0.21, 0.33±0.26). There were no complications during the surgical procedures. During the postoperative period some graft dislocations and graft failures occurred with an overall complication rate of 16.7%. The patients submitted to a combined procedure had a higher rate of complications (30% vs 10%) but this difference wasn’t statistically significant.
Conclusion: DSAEK is now considered to be the gold standard treatment for Fuchs endothelial dystrophy. Our study documented a high visual acuity increase with a low complication rate similar to those of other published studies. The association of DSAEK with cataract surgery is a safe and useful procedure. Its fast and safe recovery is associated with an important visual recovery.