Wills Eye Conference

Wills Eye Conference

Perspective from Christopher J. Rapuano, MD
March 11, 2014
2 min read
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PK for iridocorneal endothelial syndrome yields visual gains, high graft survival

Perspective from Christopher J. Rapuano, MD
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PHILADELPHIA — Penetrating keratoplasty improved vision in patients with iridocorneal endothelial syndrome, according to a study presented here.

“ICE syndrome and corneal decompensation can benefit from transplantation, but you have to be careful about intraocular pressure. You have to worry about additional surgery, not only repeat transplant but additional glaucoma surgery,” Ajay B. Shalwala, MD, said at the Wills Eye Annual Conference. “Endothelial keratoplasty has been shown to be effective in ICE syndrome. The largest series to demonstrate that is three patients. So, if we did larger studies of that, maybe we’d find that the results are even better than PK since it’s primarily an endothelial problem.”

Ajay B. Shalwala

The retrospective study included 13 patients with iridocorneal endothelial (ICE) syndrome who underwent PK between 2000 and 2013. Investigators evaluated graft survival, visual acuity and IOP.

Preoperative data were available for 10 patients. Preoperatively, five patients had counting fingers or worse vision, and five had visual acuity of 20/200 to 20/400.

At 6 months postoperatively, three of nine patients (33%) had visual acuity of 20/40 or better; one patient had visual acuity of counting fingers or worse. Nine grafts were clear. IOP remained stable, but patients required slightly more medication to manage pressure. One patient required subsequent glaucoma surgery.

At 1 year, four of eight patients (50%) had visual acuity of 20/40 or better, and all patients had clear grafts. Two patients experienced graft rejection that ultimately resolved without steroids. IOP remained stable, but patients required slightly more medication.

“Intraocular pressure issues are definitely a concern,” Shalwala said.

Disclosure: Shalwala has no relevant financial disclosures.