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Three-Year Outcome of Descemet Stripping Automated Endothelial Keratoplasty for Bullous Keratopathy After Argon Laser Iridotomy

Nakatani, Satoru MD, PhD; Murakami, Akira MD, PhD

doi: 10.1097/ICO.0000000000000157
Clinical Science

Purpose: The aim of this study was to evaluate the 3-year outcome of Descemet stripping automated endothelial keratoplasty (DSAEK) for the treatment of bullous keratopathy secondary to argon laser iridotomy (ALI).

Methods: A total of 22 consecutive patients (22 eyes) with ALI who underwent DSAEK were retrospectively analyzed. Best spectacle-corrected visual acuity (BSCVA), endothelial cell density, and complications were investigated over 3 years postoperatively. The outcome of DSAEK was also compared between the ALI group and 21 other patients with Fuchs endothelial dystrophy (FED) or pseudophakic bullous keratopathy (PBK) (FED/PBK group).

Results: The median BSCVA improved from logarithm of the minimum angle of resolution 1.40 before DSAEK to 0.30 at 6 months, 0.30 at 12 months, 0.22 at 24 months, and 0.15 at 36 months after surgery. The median endothelial cell loss was 20.3% at 6 months, 18.4% at 12 months, 32.5% at 24 months, and 46.5% at 36 months. Comparison of the ALI group with the FED/PBK group showed no significant difference in the BSCVA or endothelial cell density. Rejection affected 9.1% of the ALI group versus 0% of the FED/PBK group (P = 0.49), the graft dislocation rate was 0% versus 9.5% (P = 0.23), and posterior synechiae were found in 31.8% versus 4.8% (P = 0.046).

Conclusions: The 3-year outcome of DSAEK for bullous keratopathy after ALI was excellent. However, caution should be exercised in patients with a history of ALI to avoid posterior synechiae after DSAEK.

Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.

Reprints: Satoru Nakatani, MD, PhD, Department of Ophthalmology, Juntendo University Graduate School of Medicine, 3-1-3 Hongo Bunkyo-ku, Tokyo 113-8431, Japan (e-mail:

The authors have no funding or conflicts of interest to disclose.

This study was approved by the Ethical Committee of the Juntendo University Graduate School of Medical Science and followed the tenets of the Declaration of Helsinki.

Received March 02, 2014

Accepted April 13, 2014

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.