Outcomes of Descemet Stripping Endothelial Keratoplasty in Eyes With Anterior Chamber Intraocular Lenses.

PURPOSE: To determine the outcomes of Descemet stripping endothelial keratoplasty (DSEK) in eyes with anterior chamber intraocular lenses (ACIOLs).

METHODS

Retrospective chart review of DSEK procedures in eyes with ACIOLs from May 2006 to December 2024 and posterior chamber intraocular lenses (PCIOLs) from May 2006 to July 2020 (control group). Cox analysis of risk factors for secondary graft failure (SGF) was performed.

RESULTS

A total of 132 and 608 DSEK procedures were performed in ACIOL and PCIOL groups with a median follow-up of 21.7 and 36.8 months, respectively (P < 0.01). There were no significant differences between the groups in the mean VA improvement, or incidence of primary graft failure, graft dislocation, endothelial rejection, or postop intraocular pressure elevation, although glaucoma surgery was more common in the ACIOL group (14.4% vs. 6.7%, P < 0.01). The incidences of SGF in the ACIOL and PCIOL groups were 0.14 and 0.13 per eye-year (P = 0.47) and 0.11 and 0.01 per eye-year (P < 0.01) in eyes with and without glaucoma, respectively. An ACIOL increased the risk of SGF in eyes without glaucoma [hazard ratio (HR): 6.5 (2-21.4)], with a trend toward significance in eyes with medically treated glaucoma [HR: 1.9 (0.8-4.7)] but not in eyes with prior glaucoma surgery. Prior graft failure [HR: 1.8 (1.2-2.7)] and endothelial rejection [HR: 2.2 (1.2-3.3)] also increased the risk of SGF.

CONCLUSIONS

An ACIOL increases the risk of SGF after DSEK in eyes without glaucoma but not in eyes with prior glaucoma surgery. Therefore, IOL exchange should be considered before DSEK in eyes with an ACIOL and without prior glaucoma surgery.