DSAEK in corneal decompensation by Baikoff lens implant after traumatic cataract and superior iridodialysis

• Published in: Acta ophthalmologica (Oxford, England) Vol. 100; no. S275
• Main Authors: Clavería, Julia Aramburu, Martínez, Marta Suñer, Fernández, Miguel Castillo, Rivas, Marta Orejudo, Arias, Pablo Andrés Cisneros, Moscarda, Eva Josefina Núñez, El Bakkali, Ismael Bakkali, Rivasés, Guillermo Pérez, Puyuelo, Javier Ascaso
• Format: Journal Article
• Language: English
• Published: Malden Wiley Subscription Services, Inc 01-12-2022
• Subjects: Acuity; Anterior chamber; Cataracts; Cornea; Corneal transplantation; Dialysis; Edema; Haptics; Medical treatment; Stroma; Transplants & implants
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/j.1755-3768.2022.0387

Purpose: To present the assessment and surgical approach to late pseudophakic bullous keratopathy in a case of pseudophakia with Baikoff type anterior chamber (AC) IOL implantation with haptics synechiated to the iridian stroma. We opted for Descemet Stripping with Automated Endothelial Keratoplasty (DSAEK), which allowed us to solve the corneal decompensation.
Methods: We present the case of a 72‐year‐old male with a history of traumatic cataract and superior iridodialysis, who was surgically treated with lens extraction and implantation of a three‐haptic Baikoff‐type AC IOL. During the 30 years after surgery, the patient remained stable. However, in 2021, he went for a revision with a decrease in visual acuity. During the slit‐lamp biomicroscopic examination and the images obtained, the presence of synechiae of the three haptics of the lens to the peripheral iridian stroma was evidenced, as well as the presence of generalized edema with increased thickness and loss of corneal transparency, which did not subside with medical treatment.
Results: Given the need for surgical intervention, the risk–benefit of performing a lens explant was studied. It was decided to perform a DSAEK endothelial transplantation keeping the IOL in its position, given the existence of a wide iridian dialysis and a wide anterior chamber. During the operation, the implanted gas bubble allowed the graft to adhere properly, although it did not remain in the anterior chamber, due to the presence of the traumatic superior iridodialysis. However, in the immediate postoperative period, the graft of the posterior corneal layers remained adhered without the need of the gas bubble, resolving the previous bullous keratopathy.
Conclusions: Late corneal decompensation is a complication to be taken into account in eyes with AC IOL. On the other hand, DSAEK offers advantages in the ease of positioning and maintenance of the graft compared to DMEK in cases with iridodialysis, obtaining a prompt recovery with good refractive results.