We report the results of simultaneous astigmatic arcuate keratotomy (AK) and Descemet automated endothelial keratoplasty (DSAEK). A 55-year-old patient with a history of high myopia was referred for the management of bullous keratopathy secondary to an anterior chamber phakic intraocular lens (pIOL). IOL explantation through a 5.5-mm corneal incision, cataract extraction, and posterior chamber IOL implantation, combined with DSAEK, were performed. Postoperatively, increased astigmatism up to 2.0 diopters (Dpt) was observed, attributed to the large corneal incision, and remained stable, despite suture removal at 3 months. One year postoperatively, the graft showed signs of progressive endothelial dysfunction. A combined procedure of astigmatic AK and DSAEK was thus performed. After 6 months, topographic astigmatism was significantly reduced to 0.5 Dpt and best-corrected visual acuity increased. In conclusion, simultaneous astigmatic AK and DSAEK could be an effective combination for treating patients with well-documented pre-existing astigmatism and endothelial decompensation.
Case Rep Ophthalmol 2021;12:640–645

中文翻译：

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散光弧形角膜切开术联合 Descemet 自动内皮角膜移植术

我们报告了同时散光弓状角膜切开术 (AK) 和 Descemet 自动内皮角膜移植术 (DSAEK) 的结果。一名有高度近视史的 55 岁患者被转诊治疗继发于前房有晶状体人工晶状体 (pIOL) 的大疱性角膜病变。通过 5.5 毫米角膜切口、白内障摘除和后房人工晶状体植入术联合 DSAEK 进行人工晶状体移植。术后，观察到散光增加到 2.0 屈光度 (Dpt)，这归因于大的角膜切口，尽管在 3 个月时拆线，但仍保持稳定。术后一年，移植物显示出进行性内皮功能障碍的迹象。因此执行散光 AK 和 DSAEK 的组合程序。6个月后，地形散光显着降低至0。5 Dpt 和最佳矫正视力增加。总之，同时散光 AK 和 DSAEK 可能是治疗有充分记录的预先存在的散光和内皮失代偿的患者的有效组合。
Case Rep Ophthalmol 2021；12:640–645