Descemet Stripping Automated Endothelial Keratoplasty in the Phakic Eye

PURPOSE:To evaluate the visual acuity, graft clarity, refractive outcome, and crystalline lens clarity in phakic patients undergoing Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS:Six eyes of 4 consecutive patients with clear crystalline lenses and corneal edema because of either Fuchs dystrophy (4 eyes) or amantadine-induced corneal endothelial toxicity (2 eyes) were included in this study. All patients underwent simple DSAEK using a 4.2-mm temporal clear corneal incision. The 8.5-mm donor lenticule was folded and inserted into the anterior chamber using an Utrata forceps. A 10-minute air bubble tamponade was used. RESULTS:Best-corrected spectacle visual acuity, refractive error, graft status, and crystalline lens clarity were measured at a minimum of 6 months postoperatively. All grafts for Fuchs dystrophy remained clear, whereas 2 grafts failed because of continued amantadine corneal toxicity. Excluding the failed grafts, the average preoperative best-corrected spectacle visual acuity was 20/47 compared with 20/28 postoperatively (P = 0.0024). There were no intraoperative complications, and no eyes developed pupillary block glaucoma or cataracts during an average follow-up interval of 9.1 months (6-14 months). CONCLUSION:DSAEK may be safely performed in the phakic eye.