Descemet Stripping Endothelial Keratoplasty in Patients With a Custom Foldable Silicone Artificial Iris: Safety and Efficacy Outcomes

Tu M Tran; Clemence Bonnet; Piseth Dalin Chea; Ali Masoudi; Anthony J Aldave; David R Hardten; Kevin M Miller

doi:10.1097/ICO.0000000000003540

Descemet Stripping Endothelial Keratoplasty in Patients With a Custom Foldable Silicone Artificial Iris: Safety and Efficacy Outcomes

Cornea. 2024 May 8. doi: 10.1097/ICO.0000000000003540. Online ahead of print.

Authors

Tu M Tran¹, Clemence Bonnet², Piseth Dalin Chea³, Ali Masoudi², Anthony J Aldave², David R Hardten⁴, Kevin M Miller²

Affiliations

¹ Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN.
² Department of Ophthalmology, Jules Stein Eye Institute, David Gefen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
³ Ophthalmology Unit, Calmette Hospital, Phnom Penh, Cambodia; and.
⁴ Minnesota Eye Consultants, Minnetonka, MN.

PMID: 38718485
DOI: 10.1097/ICO.0000000000003540

Abstract

Purpose: To assess outcomes of Descemet stripping endothelial keratoplasty (DSEK) in eyes with custom artificial iris (CAI) implantation.

Methods: This is a retrospective, interventional, consecutive, surgical case series of patients who underwent DSEK after CAI implantation between 2010 and 2021 at 2 referral centers. Primary safety measures were loss of corrected distance visual acuity (CDVA), increase in intraocular pressure (IOP), development or progression of glaucoma, and intraoperative and postoperative complications. Efficacy measures were graft survival at year 1 and improvement in cosmesis at postoperative month 3. In general, measures were compared between baseline and postoperative year 1 while any complication was reported for the full follow-up period.

Results: Thirty-nine eyes of 39 patients were identified. 64.1% of eyes had acquired aniridia from trauma. The mean follow-up interval was 27.7 months (range 12.2-117.4). Median CDVA improved from logMAR 1.0 to 0.7 at year 1 (P = 0.0047). At the final follow-up, permanent loss of CDVA occurred in 25.6% of eyes, of which 90% was due to glaucoma. The most common postoperative complication was IOP elevation (66.7% of eyes). Graft survival at postoperative year 1 was 82.0% (95% confidence interval, 66.3-91.4). Secondary graft failure occurred in 28.2% of eyes at a mean duration of 39.7 months (SD 27.9 months) after DSEK. Cosmesis improved among 87.2% of eyes at postoperative month 3.

Conclusions: DSEK is an effective procedure for addressing corneal edema in eyes with a CAI, but a majority develop elevated IOP and graft survival is shorter than in eyes without a CAI.

Abstract

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