Combined Descemet-stripping automated endothelial keratoplasty and phacoemulsification with toric intraocular lens implantation for treatment of failed penetrating keratoplasty with high regular astigmatism

We present the case of a 57-year-old woman who had combined Descemet-stripping automated endothelial keratoplasty (DSAEK) and phacoemulsification with implantation of a toric intraocular lens (IOL). Surgery was intended to treat a cataract developing in a post-penetrating keratoplasty (PKP) eye with high astigmatism and endothelial decompensation. Six months after uneventful surgery, the cornea was clear and the corrected distance visual acuity was 20/20 with a refraction of +0.25 -1.00 x 10 (from -3.00 -8.50 x 12 preoperatively). The internal topography map (OPD-Scan) showed an IOL rotation of 4 degrees. The endothelial cell loss was 15% of the eye-bank value. Descemet-stripping automated endothelial keratoplasty combined with phacoemulsification and toric IOL implantation is a relatively simple and very effective procedure for eyes with endothelial failure and high post-PKP astigmatism. The speed of visual rehabilitation and final visual acuity achieved with this approach was superior to that obtained with other surgical procedures.