Meeting News CoveragePerspective

Early DSEK improves vision in post-cataract corneal edema

PHILADELPHIA — Early Descemet’s stripping endothelial keratoplasty significantly improved visual acuity in eyes that developed pseudophakic bullous keratopathy after cataract surgery, according to a study presented at the Wills Eye Alumni Conference.

“A statistically significant relationship was found between the [corneal edema] to DSEK time and post-DSEK visual acuity. Post-DSEK visual acuity was not associated with the preoperative vision or pachymetry. Performing earlier DSEK for patients with pseudophakic corneal edema may be associated with improved visual outcomes,” Sarah B. Weissbart, MD, said.

The retrospective study included 120 patients who underwent cataract surgery, developed pseudophakic bullous keratopathy and subsequently underwent DSEK. Visual outcomes were assessed 6 months after DSEK.

Mean visual acuity improved from about 20/115 preoperatively to about 20/36 after DSEK.

The interval between the development of corneal edema and DSEK surgery was closely associated with postoperative visual acuity, Weissbart said.

“As the interval between cataract surgery and DSEK increased, postoperative visual acuity worsened,” she said. “When we compared patients who underwent earlier vs. later DSEK surgery, there was no difference in preoperative pachymetry values, but there were significant differences found in both the preoperative and postoperative visual acuities.”

The mean interval between corneal edema and DSEK was 11.7 months in patients with better post-DSEK vision and 21.5 months in patients with worse post-DSEK vision, Weissbart said.

For every 1-month increase in corneal edema to DSEK time, patients were 4% less likely to achieve postoperative visual acuity of 20/40 or better, and patients were about 2.6 times more likely to have better visual acuity if they underwent DSEK within 6 months of cataract surgery, she said. – by Matt Hasson

Reference:

Weissbart SB. Influence of early EK on visual outcomes in patients with PBK. Presented at Wills Eye Alumni Conference; March 10-12; Philadelphia.

Disclosure: Weissbart reports no relevant financial disclosures.

PHILADELPHIA — Early Descemet’s stripping endothelial keratoplasty significantly improved visual acuity in eyes that developed pseudophakic bullous keratopathy after cataract surgery, according to a study presented at the Wills Eye Alumni Conference.

“A statistically significant relationship was found between the [corneal edema] to DSEK time and post-DSEK visual acuity. Post-DSEK visual acuity was not associated with the preoperative vision or pachymetry. Performing earlier DSEK for patients with pseudophakic corneal edema may be associated with improved visual outcomes,” Sarah B. Weissbart, MD, said.

The retrospective study included 120 patients who underwent cataract surgery, developed pseudophakic bullous keratopathy and subsequently underwent DSEK. Visual outcomes were assessed 6 months after DSEK.

Mean visual acuity improved from about 20/115 preoperatively to about 20/36 after DSEK.

The interval between the development of corneal edema and DSEK surgery was closely associated with postoperative visual acuity, Weissbart said.

“As the interval between cataract surgery and DSEK increased, postoperative visual acuity worsened,” she said. “When we compared patients who underwent earlier vs. later DSEK surgery, there was no difference in preoperative pachymetry values, but there were significant differences found in both the preoperative and postoperative visual acuities.”

The mean interval between corneal edema and DSEK was 11.7 months in patients with better post-DSEK vision and 21.5 months in patients with worse post-DSEK vision, Weissbart said.

For every 1-month increase in corneal edema to DSEK time, patients were 4% less likely to achieve postoperative visual acuity of 20/40 or better, and patients were about 2.6 times more likely to have better visual acuity if they underwent DSEK within 6 months of cataract surgery, she said. – by Matt Hasson

Reference:

Weissbart SB. Influence of early EK on visual outcomes in patients with PBK. Presented at Wills Eye Alumni Conference; March 10-12; Philadelphia.

Disclosure: Weissbart reports no relevant financial disclosures.

    Perspective

    We are often faced with a patient who has mild corneal edema, most commonly with a history of Fuchs’ dystrophy after cataract surgery. The question is, should we advise endothelial keratoplasty at that time, or should we suggest waiting and seeing whether the edema progresses? A randomized controlled trial would be needed to really answer this question, but that would be a huge and difficult undertaking. Dr. Weissbart’s study is one way to begin to try to answer this question.

    Dr. Weissbart looked retrospectively at eyes that underwent Descemet’s stripping endothelial keratoplasty (DSEK) sooner (6 months or less) or later (more than 6 months) after cataract surgery and compared visual outcomes. She found that the eyes that underwent DSEK sooner (6 months or less) after cataract surgery had statistically significantly worse preoperative vision and statistically significantly better postoperative vision than the eyes that had DSEK more than 6 months after cataract surgery. Similarly, the eyes that had 20/40 or better vision at 6 months had their DSEK statistically significantly sooner after their cataract surgery than the eyes with worse than 20/40 vision.

    These results suggest that we should be doing DSEK within 6 months of cataract surgery rather than waiting longer. However, we need to remember that this was not a prospective randomized study. There are many other potential reasons why vision might be worse in eyes that had DSEK later after their cataract surgery. Even so, it is interesting information to keep in mind when seeing these patients.

    • Christopher J. Rapuano, MD
    • Cornea Service, Wills Eye Hospital Philadelphia

    Disclosures: Rapuano reports no relevant financial disclosures.

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