Outcomes of Descemet Stripping Automated Endothelial Keratoplasty in Toxic Anterior Segment Syndrome After Phacoemulsification.

PURPOSE: To evaluate the visual and anatomical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with toxic anterior segment syndrome (TASS).

METHODS

Fourteen eyes of 14 patients who underwent clear corneal DSAEK for endothelial decompensation secondary to TASS after phacoemulsification were included in this prospective study. Intraoperative surgical difficulties were noted. Preoperative and postoperative evaluation of visual acuity, slit-lamp examination, intraocular pressure, central corneal thickness, and endothelial count was performed in all cases.

RESULTS

The interval between onset of TASS and DSAEK was 9 ± 3.8 months (range: 2-15 months). Intraoperative difficulties were encountered during Descemet membrane scoring, and a floppy iris with extensive pigment release was observed. The postoperative inflammatory response was more intense with the formation of a characteristic pigment ring at the host-graft junction. Secondary glaucoma developed in 57.1% (8/14) cases. All grafts were attached postoperatively. In 2 patients, DSAEK was undertaken within 3 months of occurrence of TASS. Both cases required a regraft with eventual graft failure. In the subsequent 12 cases, DSAEK was performed more than 3 months after TASS. All 12 grafts were clear with no episode of graft rejection, and the corrected visual acuity ranged from 6/18 to 6/9.

CONCLUSIONS

Successful visual and anatomical outcomes are achieved with DSAEK in cases of chronic TASS. The time interval between TASS and DSAEK is a critical factor determining long-term success, and a minimum 3- to 6-month waiting period after TASS is essential for optimal outcomes. Preoperative and postoperative control of inflammation and intraocular pressure is necessary to enhance graft survival.