TY - JOUR
T1 - Combined deep sclerectomy and descemet stripping automated endothelial keratoplasty
AU - Vaiano, Agostino Salvatore
AU - Salgarello, Tommaso
AU - Giudiceandrea, Andrea
AU - Riso, Monica
AU - Sammarco, Maria Grazia
AU - Caramello, Guido
PY - 2014
Y1 - 2014
N2 - PURPOSE:\r\nThe aim of this study was to evaluate a novel surgical combination of Descemet stripping automated endothelial keratoplasty (DSAEK) and deep sclerectomy (DS) for the management of concomitant corneal endothelial decompensation and uncontrolled glaucoma.\r\nMETHODS:\r\nThis retrospective case series noncomparative study included 9 eyes of 6 consecutive patients with coexistence of corneal edema resulting from Fuchs dystrophy or pseudoexfoliation keratopathy and medically uncompensated glaucoma; these patients underwent combined DSAEK and DS with mitomycin C and an absorbable collagen implant. Corneal graft clarity, endothelial cell density, visual acuity, intraocular pressure (IOP), and identification of complications were assessed over a 2-year follow-up.\r\nRESULTS:\r\nAll eyes obtained graft clarity throughout the follow-up, with a final average endothelial cell decrease of -36% from baseline, and showed improved vision and good IOP control without hypotensive therapy. Measured at 3 and 24 months postoperation, the mean visual acuity improvement was 154% and 372% and IOP decrease was 51.1% and 46.4%, respectively. Two anterior segment complications occurred in 2 (22%) patients' eyes. This consisted of a graft dislocation and a modest IOP elevation, treated successfully.\r\nCONCLUSIONS:\r\nCombined DSAEK and DS was longitudinally associated with good corneal graft survival and IOP control, with few complications. These findings suggest that this surgical approach is a viable option for patients with coexisting glaucoma and corneal endothelial dysfunction. Our study should stimulate a multicenter, randomized, controlled trial of our technique.
AB - PURPOSE:\r\nThe aim of this study was to evaluate a novel surgical combination of Descemet stripping automated endothelial keratoplasty (DSAEK) and deep sclerectomy (DS) for the management of concomitant corneal endothelial decompensation and uncontrolled glaucoma.\r\nMETHODS:\r\nThis retrospective case series noncomparative study included 9 eyes of 6 consecutive patients with coexistence of corneal edema resulting from Fuchs dystrophy or pseudoexfoliation keratopathy and medically uncompensated glaucoma; these patients underwent combined DSAEK and DS with mitomycin C and an absorbable collagen implant. Corneal graft clarity, endothelial cell density, visual acuity, intraocular pressure (IOP), and identification of complications were assessed over a 2-year follow-up.\r\nRESULTS:\r\nAll eyes obtained graft clarity throughout the follow-up, with a final average endothelial cell decrease of -36% from baseline, and showed improved vision and good IOP control without hypotensive therapy. Measured at 3 and 24 months postoperation, the mean visual acuity improvement was 154% and 372% and IOP decrease was 51.1% and 46.4%, respectively. Two anterior segment complications occurred in 2 (22%) patients' eyes. This consisted of a graft dislocation and a modest IOP elevation, treated successfully.\r\nCONCLUSIONS:\r\nCombined DSAEK and DS was longitudinally associated with good corneal graft survival and IOP control, with few complications. These findings suggest that this surgical approach is a viable option for patients with coexisting glaucoma and corneal endothelial dysfunction. Our study should stimulate a multicenter, randomized, controlled trial of our technique.
KW - DSAEK
KW - deep sclerectomy
KW - DSAEK
KW - deep sclerectomy
UR - https://publicatt.unicatt.it/handle/10807/60829
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=84927663101&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84927663101&origin=inward
U2 - 10.1097/ICO.0000000000000268
DO - 10.1097/ICO.0000000000000268
M3 - Article
SN - 0277-3740
VL - 33
SP - 1300
EP - 1306
JO - Cornea
JF - Cornea
IS - 12
ER -