Management of pseudophakic bullous keratopathy by combined Descemet-stripping endothelial keratoplasty and intraocular lens exchange

PURPOSE: To evaluate visual recovery results in 11 patients with anterior pseudophakia and corneal endothelial dysfunction who had Descemet-stripping endothelial keratoplasty (DSEK) combined with anterior chamber intraocular lens (IOL) removal and scleral fixation of a posterior chamber IOL. SETTING: Department of Ophthalmology, District Railway Hospital Katowice, Katowice, Poland. METHODS: Eleven consecutive patients had DSEK combined with IOL exchange. Corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD), visual outcomes, and complication rates were measured during the follow-up. RESULTS: The mean age of patients was 76 years. All corneas remained clear during the mean 19.3-month follow-up. At the last visit, the mean uncorrected visual acuity was 0.16 (range 0.001 to 0.50) and the mean best corrected visual acuity, 0.36 (range 0.001 to 0.80). The mean spherical equivalent was + 0.30 diopter (D) (range -2.00 to + 2.25 D) and the mean astigmatism, 2.20 D (range 1.25 to 3.00 D). Three eyes with endothelial disk detachment required reinjection of air. Corneal rejection was observed in 1 eye 3 months postoperatively. Two eyes had flap erosion over the fixation suture. The mean CCT was 0.837 mu m preoperatively and 0.605 mu m postoperatively. The mean ECD was 3198 cells/mm(2) in donor lenticules and 2048 cells/mm(2) at the last follow-up visit. Endothelial cell loss was 36%. CONCLUSION: Descemet-stripping endothelial keratoplasty combined with anterior chamber IOL replacement with a scleral-fixated posterior chamber IOL was a safe method for the management of pseudophakic bullous keratopathy.