Endothelial Cell Survival After Descemet Stripping With Automated Endothelial Keratoplasty With Retained Anterior Chamber Intraocular Lens

Purpose: To evaluate the donor endothelial cell loss in the first year after Descemet stripping endothelial keratoplasy (DSAEK) for the treatment of endothelial dysfunction in the presence of an anterior chamber (AC) intraocular lens (IOL). Methods: We performed a retrospective study of a surgical case series of 25 patients who underwent DSAEK in the presence of an AC IOL. The donor central endothelial cell density (ECD) was recorded at 6 months and 1 year postoperatively and then compared with the preoperative eye bank values. Results: The average and SD ECD at 6 months was 1876 6 286 cells per square millimeters representing a mean cell loss from preoperative ECD measurement of 37% +/- 13%. At 1 year postoperatively, ECD was 1793 6 311 cells per square millimeters that correspond to a 40% +/- 11% cell loss from preoperative ECD measurement. The increased cell loss between 6 months and 1 year was not significant statistically (P = 0.365). Conclusions: DSAEK in the presence of a well-centered AC IOL and an AC depth greater than 3 mm has a mean donor endothelial cell loss of 37% at 6 months and 40% at 12 months postoperatively. We found no difference in cell loss in our series compared with previous ECD loss in DSAEK surgery alone. Emphasis in a surgical technique that minimizes tissue manipulation and reduces the risk of graft-AC IOL touch should be considered to maximize the endothelial graft survival in these cases.