One-Year Results After Combined Phacoemulsification
and Deep Lamellar Endothelial Keratoplasty (Phaco/DLEK)
Sudeep Pramanik, MD, MBA
Christopher Robinson, MD,
John Sutphin, MD, Kenneth Goins, MD, sponsors
Purpose: To report
best spectacle corrected visual acuity (BSCVA) results one year after combined
Phaco/DLEK for cataract and Fuchs' dystrophy. Secondary outcomes include
postoperative spherical equivalent, endothelial cell counts, keratometric
astigmatism, and wavefront aberrations.
Methods: A retrospective,
consecutive review of patients with visually significant cataract and Fuchs
dystrophy who underwent combined Phaco/DLEK at the University of Iowa and had at least 12 months of postoperative follow-up was performed. Baseline data
included age, BSCVA, preoperative keratometric astigmatism, wavefront
aberrations, target refraction, and donor endothelial cell counts. Outcome
measures were recorded 1, 3, 6, and 12 months postoperatively.
Results: Among the
12 eyes of 12 patients, the mean age at surgery was 70.58 (+/-8.34) years.
Preoperatively, the mean BSCVA was 20/70 (range 20/30-20/250), mean
keratometric astigmatism was 1.55 D (+/-1.61), mean total wavefront aberration
(RMS) was 3.27mm (+/-4.57), mean lower
order aberration (LOA) was 2.40 mm (+/-3.11)
and mean higher order aberration (HOA) was 1.92 mm
(+/-3.41). The mean target spherical equivalent was -0.62 D (+/-0.75) and the
mean baseline donor endothelial cell density was 3067 c/mm2
(+/-389). One year postoperatively, the mean BSCVA was 20/40 (range
20/20-20/100), mean spherical equivalent was 0.25 D (+/-1.47), mean
keratometric astigmatism was 1.19 D (+/-0.72), mean RMS was 1.13 mm (+/-0.69), mean LOA was 0.82 mm (+/-0.41), and mean HOA was 0.62 mm (+/-0.7). Endothelial cell counts at one
year were 2235 c/mm2 (+/-410).
Conclusions:
Combined Phaco/DLEK offers good visual rehabilitation for patients with Fuchs
and cataract. It results in minimal keratometric astigmatism and reduced
wavefront aberration with acceptable endothelial levels one year after surgery.
Support: An unrestricted grant from Research to Prevent Blindness.
