Descemet-stripping automated endothelial keratoplasty in eyes with toxic anterior segment syndrome after cataract surgery

Purpose To report the results of Descemet-stripping automated endothelial keratoplasty (DSAEK) in eyes with toxic anterior segment syndrome (TASS) after cataract surgery. Setting Department of Ophthalmology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey. Methods In this prospective study of consecutive patients who had DSAEK for corneal failure due to TASS, the main outcome measures were corneal clarity, mean spherical equivalent (SE) refraction, preoperative and postoperative visual acuities, central corneal thickness, and endothelial cell count (ECC). Results The mean follow-up in the 10 eyes (10 patients) was 17.1 months ± 2.4 (SD). There were no graft dislocations postoperatively, and no graft required repositioning. All grafts were clear at 12months. Two eyes had initial graft rejection that resolved with treatment. All eyes had improved postoperative corrected distance visual acuity, with 7 eyes (70%) attaining 0.5 or better. The mean SE refraction in measurable cases (5 eyes) was 1.2 ± 0.6 preoperatively and 0.9 ± 1.0 postoperatively (P= .141). The decrease in mean pachymetry from preoperatively (691 ± 15 μm) to 12 months postoperatively (614 ± 23 μm) was statistically significant (P=.005). The mean ECC was 2740 ± 236 cells/mm2preoperatively, 1690 ± 209 cells/mm2at 6 months, and 1683 ± 206 cells/mm2at 12 months. The decrease between preoperatively and 6 and 12 months (P= .05) and between 6 months and 12 months (P= .008) was statistically significant. Conclusion Descemet-stripping automated endothelial keratoplasty was safe and effective in eyes with TASS-associated corneal edema, yielding encouraging surgical and visual outcomes