JAN 28, 2009
Francis Price, Jr., MD, previously reported successful endothelial keratoplasty without Descemet membrane peeling for bullous keratopathies without guttata. In this article, the authors termed the procedure nDSAEK and evaluated clinical outcomes of this procedure for bullous keratopathies secondary to argon laser iridotomy.
Their prospective case series included six patients (six eyes) with bullous keratopathies secondary to argon laser iridotomy who underwent combined phacoemulsification, IOL implantation and nDSAEK. The authors used their current donor insertion technique using a Busin glide and an IOL sheet glide (Kobayashi double-glide insertion technique).
After six months, all of the patients reached BCVA of 20/32. Two obtained 20/20 BCVA, which the authors said suggested rapid and superior visual functional recovery compared with conventional penetrating keratoplasty. Mean endothelial cell density loss from preoperative donor cell measurements was 25.8 percent. Mean induced astigmatism in measureable cases was 0.85 diopters. Complications of note were one case each of graft dislocation that required rebubbling and subclinical endothelial rejection that resolved with frequent steroid eye drop use.
The authors conclude that this technique combined with the double-glide insertion technique may be quite useful for eyes with argon laser iridotomy-related bullous keratopathies. Currently, it is their preferred method for these patients and for other non-Fuchs-type endothelial dysfunction.