1. Endothelial Keratoplasty: Does DSAEK With IOL Exchange Have Different Outcomes Than DSAEK Alone?
Anand K Shah MD1
Neda Shamie MD1
Paul Phillips MD1
Mark A Terry MD1,2*
David Davis-Boozer MPH2
Daniel Friend MS2
1Devers Eye Institute
2The Lions Eye Bank of Oregon Vision Research Laboratory
Portland, OR
*Dr. Terry has a financial interest in instruments he developed for DSAEK (Bausch & Lomb); Other authors have no financial interest

2. Introduction
DSAEK  transplantation technique for damaged/diseased endothelium that provides excellent visual rehabilitation
Major complications associated with DSAEK
Dislocations
Primary graft failures
Endothelial cell loss
With additional anterior segment surgery (i.e. IOL Exchange), do complications associated with DSAEK increase?
Can a combined approach be a safe and effective management option for patients?

3. Prior Publications of DSAEK w/ IOL Exchange: One Article
Case Series of 11 eyes
Complications
3/11 dislocations (27%)
0 primary graft failure episodes
Mean endothelial cell loss: 36% at 9-26 months
Conclusion: Combined DSEK w/ IOL Exchange is a safe method for management of PBK
**No comparison to control DSAEK group
Wylegala E, Tarnawska D. Management of pseudophakic bullous keratopathy by combined Descemet-
stripping endothelial keratoplasty and intraocular lens exchange. J Cataract Refract Surg 2008: 34:

4. Purpose of This Study
To evaluate complications and clinical outcomes of Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) with intraocular lens (IOL) exchange compared to DSAEK alone

5. Methods 2 groups Outcomes Measured:
Group 1 (Study Group) (N=19): DSAEK with the anterior chamber IOL exchanged for a posterior chamber IOL
Group 2 (Comparison Group) (N=233): DSAEK with the posterior chamber IOL left in place
Outcomes Measured:
Complications
Dislocations
Primary graft failure rates
Visual acuity at 6 and 12 months postoperatively
Endothelial cell counts at 6 and 12 months postoperatively

6. Demographics Mean Ages
DSAEK w/ IOL Exchange (N=19): /-10.8 years
Range: years
DSAEK only (N=233): / years
Range: years

7. Indications for Transplant
Study Group
Comparison Group

8. **No statistically significant differences at any time point
20/120
20/178
P=0.414
P=0.850
20/44
20/51
20/44
20/41
**No statistically significant differences at any time point

9. **No statistically significant differences at any time point
2759
2713
P=0.126
P=0.127
1983
1849
1955
1818
**No statistically significant differences at any time point

10. **No statistically significant differences at any time point
100%
100%
P=0.205
P=0.226
72%
68%
71%
67%
**No statistically significant differences at any time point

11. Summary of Results: Complications
Dislocations
0/19 eyes (0%) in DSAEK w/ IOL Exchange Group
7/233 eyes (3%) in DSAEK Group
p=0.44
Primary Graft Failures (PGF)
0/233 eyes (0%) in DSAEK Group
**No statistically significant differences

12. Conclusions
Concurrent IOL exchange combined with DSAEK surgery does not increase the dislocation rate.
Combined DSAEK w/ IOL Exchange Surgery did not lead to any primary graft failure episodes.
Furthermore, there was no difference in visual acuity or the donor cell loss when compared to DSAEK alone at 6 and 12 months postoperatively.