Management of pseudophakic bullous keratopathy by combined Descemet- stripping endothelial keratoplasty and intraocular lens exchange Edward Wyl˛ ega1a, MD, PhD, Dorota Tarnawska, MD PURPOSE: To evaluate visual recovery results in 11 patients with anterior pseudophakia and corneal endothelial dysfunction who had Descemet-stripping endothelial keratoplasty (DSEK) combined with anterior chamber intraocular lens (IOL) removal and scleral fixation of a posterior chamber IOL. SETTING: Department of Ophthalmology, District Railway Hospital Katowice, Katowice, Poland. METHODS: Eleven consecutive patients had DSEK combined with IOL exchange. Corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD), visual outcomes, and complication rates were measured during the follow-up. RESULTS: The mean age of patients was 76 years. All corneas remained clear during the mean 19.3-month follow-up. At the last visit, the mean uncorrected visual acuity was 0.16 (range 0.001 to 0.50) and the mean best corrected visual acuity, 0.36 (range 0.001 to 0.80). The mean spherical equivalent was C0.30 diopter (D) (range À2.00 to C2.25 D) and the mean astigmatism, 2.20 D (range 1.25 to 3.00 D). Three eyes with endothelial disk detachment required reinjection of air. Corneal rejection was observed in 1 eye 3 months postoperatively. Two eyes had flap erosion over the fixation suture. The mean CCT was 0.837 mm preoperatively and 0.605 mm postoperatively. The mean ECD was 3198 cells/mm 2 in donor lenticules and 2048 cells/mm 2 at the last follow-up visit. Endothelial cell loss was 36%. CONCLUSION: Descemet-stripping endothelial keratoplasty combined with anterior chamber IOL replacement with a scleral-fixated posterior chamber IOL was a safe method for the management of pseudophakic bullous keratopathy. J Cataract Refract Surg 2008; 34:1708–1714 Q 2008 ASCRS and ESCRS Descemet-stripping endothelial keratoplasty (DSEK) is a transplantation technique that allows selective re- moval of diseased or dysfunctional host endothelium, a procedure that is not possible with penetrating kera- toplasty (PKP). 1,2 Pseudophakic bullous keratopathy (PBK) is a leading indication for keratoplasty, although anterior chamber PBK is less common today. 3 Of the 200 to 220 corneal transplants performed each year at our clinic, 10 are for anterior chamber PBK. In this article, we report visual recovery after a rela- tively new combination of surgical techniquesdDSEK and intraocular (IOL) exchangedin a small series of 11 patients with anterior pseudophakia and corneal en- dothelial dysfunction. To our knowledge, the existing reports in the literature of similar surgery are of single cases only. We modified the IOL-suturing procedures and measured corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD), visual outcomes, and complication rates. Accepted for publication June 6, 2008. From the Department of Ophthalmology, District Railway Hospital Katowice, Katowice, Poland. Neither author has a financial or proprietary interest in any material or method mentioned. Presented at the ASCRS Symposium on Cataract, IOL and Refrac- tive Surgery, San Diego, California, USA, April 2007. Corresponding author: Edward Wylegala, Filarowa 5a, 40-565 Katowice, Poland. E-mail: wylegala@gmail.com. Q 2008 ASCRS and ESCRS 0886-3350/08/$dsee front matter Published by Elsevier Inc. doi:10.1016/j.jcrs.2008.06.015 1708 ARTICLE