Quadruple Procedure for Visual Rehabilitation of Endothelial Decompensation Following Phakic Intraocular Lens Implantation

Nahum, Yoav; Busin, Massimo

doi:10.1016/j.ajo.2014.09.002

Cited by 14 publications

(13 citation statements)

References 20 publications

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“…Besides, this subset of patients consists of relatively young patients who underwent refractive surgery with no previous ocular comorbidities and therefore have high visual and refractive demands. Only a few case reports and case series have described the management of corneal decompensation in patients with pIOL [14–18]. To the best of our knowledge, this is the first case series describing the two-step procedure, bilensectomy followed by DMEK for the management of this entity, with its clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Previous case reports and case series have described mainly penetrating keratoplasty [7] and Descemet stripping automated endothelial keratoplasty [14–16, 18] in cases of bullous keratopathy secondary to pIOLs. Only Liarakos et al [17] report DMEK surgery in 8 eyes with previous pIOLs (7 eyes which had the pIOL explanted elsewhere but crystalline lens left in situ and 1 eye where the pIOL was not explanted before DMEK).…”

Section: Discussionmentioning

confidence: 99%

“…DMEK could have also been combined with simultaneous pIOL explantation and cataract surgery, the so-called quadruple procedure. Quadruple procedure has been previously described with Descemet stripping automated endothelial keratoplasty [15, 18]. Although it can also be feasible with DMEK, we prefer the two-step procedure because of several reasons.…”

Section: Discussionmentioning

confidence: 99%

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Descemet Membrane Endothelial Keratoplasty for Corneal Decompensation Secondary to Phakic Intraocular Lenses

López

Peris-Martínez

2019

Journal of Ophthalmology

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Purpose To describe the surgical technique and clinical outcomes of bilensectomy (pIOL explant and phacoemulsification), followed by DMEK performed for bullous keratopathy secondary to pIOL. Methods Seven eyes of seven patients, who developed corneal decompensation after pIOL implantation, underwent bilensectomy followed by DMEK in a two-step procedure. Main outcome measures included uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), refraction, endothelial cell density (ECD) at 1, 3, 6, and 12 months, and intraoperative and postoperative complications. Results DMEK was performed at a mean time of 9.83 ± 8.23 months after bilensectomy. BCVA (log MAR) improved in all eyes, increasing from 1.11 ± 0.78 preoperatively to 0.54 ± 0.21, 0.28 ± 0.23, 0.21 ± 0.21, and 0.17 ± 0.17 at 1, 3, 6, and 12 months after DMEK. One year after surgery, mean spherical equivalent and cylinder were −0.70 ± 0.92 D and −1.50 ± 0.54 D, respectively. ECD decreased by 62 ± 4%, 69 ± 4%, 74 ± 4%, and 77 ± 3% at 1, 3, 6, and 12 months after DMEK. There was one case of primary graft failure and no other postoperative complications. Conclusions The two-step technique bilensectomy followed by DMEK is a feasible technique for the management of bullous keratopathy secondary to pIOL, providing a fast visual recovery with good visual and refractive results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Descemet Membrane Endothelial Keratoplasty for Corneal Decompensation Secondary to Phakic Intraocular Lenses

López

Peris-Martínez

2019

Journal of Ophthalmology

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“…More precisely, the Artisan (Artisan, Ophtec BV) IOL phakic iris-claw implant has been associated with significant, long-term corneal endothelial cell loss [ 1 , 2 ]. In patients who develop pIOL-related endothelial decompensation, a combined surgical approach involving pIOL removal, phacoemulsification, posterior chamber IOL implantation, and endothelial keratoplasty represents a favorable treatment option [ 3 ]. Descemet automated endothelial keratoplasty (DSAEK) has become the mainstay of surgical treatment for addressing corneal endothelial dysfunction [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Combined Astigmatic Arcuate Keratotomy with Descemet Automated Endothelial Keratoplasty

Bijon¹,

Petrelli²,

Salmon³

et al. 2021

Case Rep Ophthalmol

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We report the results of simultaneous astigmatic arcuate keratotomy (AK) and Descemet automated endothelial keratoplasty (DSAEK). A 55-year-old patient with a history of high myopia was referred for the management of bullous keratopathy secondary to an anterior chamber phakic intraocular lens (pIOL). IOL explantation through a 5.5-mm corneal incision, cataract extraction, and posterior chamber IOL implantation, combined with DSAEK, were performed. Postoperatively, increased astigmatism up to 2.0 diopters (Dpt) was observed, attributed to the large corneal incision, and remained stable, despite suture removal at 3 months. One year postoperatively, the graft showed signs of progressive endothelial dysfunction. A combined procedure of astigmatic AK and DSAEK was thus performed. After 6 months, topographic astigmatism was significantly reduced to 0.5 Dpt and best-corrected visual acuity increased. In conclusion, simultaneous astigmatic AK and DSAEK could be an effective combination for treating patients with well-documented pre-existing astigmatism and endothelial decompensation.

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“…The numbers are impressive in this clinical series, by far the largest published, and only comparable to those reported in 2006 by Alió et al 4 Our first question is why the authors did not perform endothelial keratoplasty instead of penetrating keratoplasty, when the case required bilensectomy followed by corneal transplantation. 5 When analyzing the explantations due to cataract, knowing the age of this subgroup of patients would have helped to make a better analysis of the influence of surgical trauma and presence of PIOL versus senile cataract.…”

mentioning

confidence: 99%

Causes of Explantation of Phakic Intraocular Lenses

Galvis¹,

Tello²,

Cuadros³

et al. 2015

J Refract Surg

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Quadruple Procedure for Visual Rehabilitation of Endothelial Decompensation Following Phakic Intraocular Lens Implantation

Cited by 14 publications

References 20 publications

Descemet Membrane Endothelial Keratoplasty for Corneal Decompensation Secondary to Phakic Intraocular Lenses

Descemet Membrane Endothelial Keratoplasty for Corneal Decompensation Secondary to Phakic Intraocular Lenses

Combined Astigmatic Arcuate Keratotomy with Descemet Automated Endothelial Keratoplasty

Causes of Explantation of Phakic Intraocular Lenses

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