If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Treating Corneal Disease, Removing Cataract Simultaneously May Have Benefits to Performing Surgeries Sequentially: Presented at ARVO By Cameron Johnston FT. LAUDERDALE, Fla -- May 8, 2009 -- Descemet Stripping Endothelial Keratoplasty (DSEK) is a beneficial treatment for patients with a number of pathologies of the cornea, including Fuch's endothelial dystrophy and corneal oedema, researchers stated here on May 4 at the Association for Research in Vision and Ophthalmology (ARVO) 2009 Annual Meeting. Typically, these conditions arise in older patients who may also have cataracts, and the practice has been to treat the corneal disease and the cataract removal as separate procedures. The 2 surgeries are often performed weeks or months apart, with or without the implantation of an intra-ocular lens (IOL). Farrah Newman MD, University of Mississippi Medical Center, Jackson, Mississippi, and colleagues performed all 3 procedures -- DSEK, phacoemulsification, and IOL implant -- simultaneously, with positive short-term refractive outcomes. Until quite recently, patients with Fuch's syndrome and other diseases of the corneal endothelium have had few treatment options. Cornea transplant, if available, was usually their only hope. The DSEK procedure entails opening the edge of the cornea with a small slit, similar to what the ocular surgeon would do when removing a cataract. The inner layer of the cornea is then "scraped" to remove the diseased tissue. The endothelium is replaced with a new layer, consisting of a cadaver cornea. This section of cornea is folded into the shape of a taco and inserted inside the patient's open anterior chamber. It is held in place against the diseased cornea with compressed air. Among the benefits of DSEK is that the patient spends less time waiting for a corneal transplant, and there is less risk of complication once the transplant material becomes available. In the study, 8 eyes had the DSEK-phacoemulsification-IOL implant done at the same time. These patients had a mean postoperative best corrected visual acuity (BCVA) of 20/50 at 1 month, 20/40 at 2 months, and 20/30 at 4 months. By comparison, 7 eyes had the procedures done in stages and had postoperative BCVA of 20/100, 20/50, and 20/40 at months 1, 2, and 4 respectively. These differences were significant at the 1- and 2-month measurements only. By month 4, the difference in VA still favoured patients who had the procedures done together, but this difference was only marginal. There were no differences in postoperative spherical equivalent (SE) refractive errors between the 2 groups: 83% of patients were within 1.00 diopter (D) of emmetropia and 100% were within 2.00 D of emmetropia. As for adverse outcomes, 3 of 8 eyes (37%) in the triple procedure experienced rejections of the graft, and 2 of the 7 (28%) eyes in the sequential procedure had rejections. Dr. Newman concluded that the outcomes between doing DSEK-cataract surgery as a combination procedure, compared with DSEK-cataract as staged, or sequential procedures were more or less similar. However, there were advantages for the patients who had the simultaneous surgeries, in terms of convenience, time spent with their eyes bandaged, and in the need to take antibiotics. The data seem to show that patient rehabilitation is faster for those having the combined procedure compared with those who had the operations done sequentially.
[Presentation title: A Comparative Study: Descemet Stripping Endothelial Keratoplasty and Phacoemulsification With Intraocular Lens Implantation as a Staged Versus Triple Procedure. Abstract 2217/D748]
|
