From the Guidelines
Yes, cataracts can develop as a secondary complication following Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK). This occurs because DSAEK surgery, which replaces the damaged inner layer of the cornea, can accelerate cataract formation in patients who still have their natural lens, as noted in the 2024 study on corneal edema and opacification preferred practice pattern 1. The procedure involves manipulation near the lens, potentially causing mechanical trauma or inflammation that affects lens clarity. Additionally, the use of corticosteroids post-DSAEK can contribute to cataract development, as steroid-induced cataracts are a known side effect of prolonged steroid therapy.
Some key points to consider in the development of cataracts post-DSAEK include:
- The risk of cataract progression is particularly significant in patients with pre-existing lens opacity before DSAEK, as highlighted in the discussion on endothelial keratoplasty 1.
- Patients undergoing DSAEK should be monitored for early signs of cataract formation during follow-up visits, which typically occur at 1 day, 1 week, 1 month, 3 months, and 6 months post-surgery.
- Some surgeons now consider combined procedures (DSAEK with cataract extraction and intraocular lens implantation) for patients over 50 with early lens changes to avoid the need for a second surgery later, taking into account the potential hyperopic shift after DSAEK 1.
- Endothelial keratoplasty (EK) has become the preferred procedure for endothelial failure due to its benefits, including more rapid visual rehabilitation and reduced risk of immune-mediated rejection of the transplanted tissue and less induced astigmatism, as discussed in the 2024 study on corneal edema and opacification preferred practice pattern 1.
Given the potential for cataract development post-DSAEK, it is crucial for patients to be closely monitored and for surgeons to consider the timing and potential need for cataract surgery in conjunction with DSAEK, especially in patients with pre-existing lens opacity or those over 50, as supported by the most recent evidence 1.
From the Research
Cataract Development after DSAEK
- Cataracts can indeed be a secondary complication following Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) 2, 3, 4, 5, 6
- The development of cataracts is common after phakic DSAEK and may be associated with considerable ocular morbidity 2
- A study found that visually significant cataracts occurred in 4 eyes (40%) in the first postoperative year and required surgical intervention 2
Risk Factors for Cataract Development
- A significant difference in the mean anterior chamber depth was detected between eyes that developed cataracts and those that did not (P = 0.005) 2
- Preoperative anterior chamber depth of less than 2.80 mm was associated with cataract development in 3 eyes 2
- Pupillary block with markedly elevated intraocular pressure during the first 24 postoperative hours was also associated with cataract development 2
Complications of DSAEK
- Graft detachment is the most common complication of DSAEK, but postoperative repositioning or rebubbling can allow for graft reattachment in most cases 3
- Other complications of DSAEK include graft failure, graft rejection, cystoid macular edema, retinal detachment, suprachoroidal hemorrhage, and pupillary block 3, 5
- Chronic increased intraocular pressure and immune-mediated graft rejections are also potential long-term complications of DSAEK 5