Combined Descemet stripping automated endothelial keratoplasty and intraocular lens exchange using intrascleral haptic fixation (Yamane technique): clinical outcomes and literature review

PURPOSE: To describe the clinical outcomes of combined Descemet stripping automated endothelial keratoplasty (DSAEK) and intraocular lens (IOL) exchange using the Yamane technique, and to review the literature. METHODS: This is a retrospective interventional case series. Included were patients with decompensated cornea and dislocated IOL, anterior-chamber IOL, or iris-claw IOL that underwent IOL exchange using the Yamane technique combined with suture pull-through DSAEK. Best-corrected visual acuity (BCVA), graft survival, and complications were evaluated at year 1. RESULTS: Twenty-four eyes from 24 patients were included. Mean age was 71 ± 14.2 years. All except 1 patient (95.8%) had concomitant issues that could limit visual outcome or success of surgery, such as glaucoma (62.5%, of which 47.0% had previously undergone glaucoma tube surgery). Mean BCVA improved from 20/590 to 20/93 1 year after surgery (p = 0.0001). Rebubbling was performed in 4 eyes (16.7%), and 2 eyes (8.3%) had graft failure requiring repeat DSAEK. None had graft rejection. Two eyes (8.3%) developed IOL issues (1 haptic-optic junction dislocation and 1 haptic-optic junction rotation), 6 eyes (25.0%) had ocular hypertension requiring topical treatment, and 1 eye had suprachoroidal hemorrhage. CONCLUSIONS: Combined DSAEK and IOL exchange using the Yamane technique was shown to be a safe and effective method for visual rehabilitation in patients with decompensated cornea and anterior chamber/iris-claw/dislocated IOL. Further studies are required to evaluate the long-term stability of the graft and the IOL.