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    DSAEK Rebubbling & IOL Opacification

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    The air bubble used to hold a corneal graft in place may contribute to intraocular lens (IOL) opacification, according to a case review of eyes that underwent Descemet’s stripping automated endothelial keratoplasty (DSAEK) at Bristol Eye Hospital in the United Kingdom.1

    “Repeated prolonged intracameral injections of air, along with the presence of hydrophilic acrylic lenses, seem to be the major risk factors for IOL opacification,” said Muhammad A. Ahad, MBBS, FRCS, PhD, lead author of the review of DSAEK surgeries he and colleagues performed between 2008 and 2012.

    The authors reviewed eyes of 137 patients. All eyes were already pseudophakic or had cataract surgery performed at the time of DSAEK. Nearly 10 percent of eyes experienced IOL clouding, observed at a median of 17 months after DSAEK. Rebubbling, the only significant risk factor for opacification, had been performed in 62.5 percent of opacification cases, versus 23 percent with no clouding.

    Suspecting that opacification was the result of prolonged high-pressure air tamponade in the anterior chamber, the surgeons reduced the length of tamponade from 40 minutes to 10. Subsequently, the rate of graft dislocation and rebubbling has fallen, and so have cases of opacification, Dr. Ahad said.

    Data were not available on the IOL type in patients who had prior cataract surgery, but Dr. Ahad said there’s evidence that almost all affected lenses were hydrophilic acrylic. Thus, he now uses hydrophobic lenses more frequently, especially in younger patients with Fuchs dystrophy. “Now that we know the risk factors and our techniques have evolved, this complication has become very rare.”

    —Miriam Karmel 

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    1 Ahad MA et al. Cornea. 2014;33(12):1307-1311.

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    Dr. Ahad reports no related financial interests.

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