Effect of preoperative duration of stromal edema in bullous keratopathy on early visual acuity after endothelial keratoplasty

Abstract Purpose To elucidate visual outcome of patients after combined Descemet stripping endothelial keratoplasty (DSEK) with scleral fixated intra ocular lens (SFIOL) implantation in patients of endothelial decompensation with coexistent aphakia or lens subluxation. Materials and Methods A prospective interventional study of combined DSEK with sutured SFIOL in the patients who have undergone surgery at our center over 6-month follow-up period. Preoperative visual acuity and slit lamp findings were documented. Postoperative follow-up was done at days 1, 3, and 7 subsequently, months 1 and 3, and thereafter monthly till the sixth month. Results Mean age of the patients was 60.47 years. Six patients had aphakic bullous keratopathy, while 11 patients had pseudophakic bullous keratopathy with subluxated posterior chamber IOL (PCIOL). Preoperative visual acuity ranged from hand movements close to face (LogMar 2.4) with accurate projection of rays to 1/60 (LogMar 2) due to existing corneal edema and aphakia. Postoperatively uncorrected visual acuity at 6 months improved up to 6/36 (LogMar 0.8) in all cases. There was gradual improvement in corneal clarity and compactness during the follow-up. A good donor tissue endothelial count and an adequate IOP control were vital prognostic factors for the successful outcome. Conclusion This novel surgical merger reduces the complications of lenticule dislocation into vitreous and repeated surgeries and shows results akin to when performed in a staged manner.

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Spontaneous Corneal Clearance in the Presence of a Partially Detached Graft after Non-Descemet Stripping Automated Endothelial Keratoplasty

Case Reports in Ophthalmology ◽

10.1159/000443632 ◽

2016 ◽

Vol 7 (2) ◽

pp. 320-326 ◽

Cited By ~ 1

Author(s):

Konstantinos Droutsas ◽

Apostolos Lazaridis ◽

Chrysanthi Koutsandrea ◽

Klio I. Chatzistefanou ◽

Marilita M. Moschos ◽

...

Keyword(s):

Endothelial Cells ◽

Visual Acuity ◽

Bullous Keratopathy ◽

Spontaneous Clearance ◽

Endothelial Keratoplasty ◽

Invasive Treatment ◽

Corrected Visual Acuity ◽

Simplex Virus ◽

The Right

Purpose: To report the explantation of a detached and opaque donor disc as an alternative to secondary keratoplasty in a case of persistent graft detachment followed by spontaneous clearance of the recipient cornea after non-Descemet stripping automated endothelial keratoplasty (non-DSAEK). Methods: A 57-year-old man with cataract and bullous keratopathy after herpes simplex virus endotheliitis of the right eye and best spectacle-corrected visual acuity (BSCVA) of 0.1 underwent simultaneous phacoemulsification and non-DSAEK. Due to early detachment of the donor disc, two additional intracameral air injections were necessary in order to achieve graft attachment. However, the donor disc gradually detached and became fibrotic while the recipient cornea anterior to the detached graft became transparent and without any edema. Therefore, a mere explantation of the DSAEK graft was performed. Results: Four months after graft explantation, BSCVA was 0.5 and endothelial cell density (ECD) was 1,221 cells/mm2. After 13 months, BSCVA was still 0.6 while ECD had fell to 800, and 2 years later, the endothelium decompensated. BSCVA was 0.3 and ECD was not measurable. Conclusions: To our knowledge this is the first report of explantation of an endothelial graft as an alternative to re-keratoplasty in a case of spontaneous corneal clearance. This minimally invasive treatment may be considered in similar cases. However, due to the ongoing loss of endothelial cells after endothelial keratoplasty, a re-keratoplasty may still be needed in the long term.

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Does Preoperative or Postoperative Graft Thickness Influence Postoperative Visual Acuity in Descemet Stripping Automated Endothelial Keratoplasty for Advanced Pseudophakic Bullous Keratopathy?

Cornea ◽

10.1097/ico.0000000000002111 ◽

2019 ◽

Vol 38 (11) ◽

pp. 1358-1363

Author(s):

Jean-Marc Perone ◽

Pauline Rolland Le Moal ◽

Maxime Sot ◽

Florian Bloch ◽

Alireza Maleki ◽

...

Keyword(s):

Visual Acuity ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Postoperative Visual Acuity ◽

Pseudophakic Bullous Keratopathy ◽

Graft Thickness

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Combined DSEK and Transconjunctival Pars Plana Vitrectomy

Case Reports in Ophthalmological Medicine ◽

10.1155/2016/9728035 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Mona Sane ◽

Naazli Shaikh ◽

Saad Shaikh

Keyword(s):

Visual Acuity ◽

Surgical Technique ◽

Pars Plana Vitrectomy ◽

Posterior Segment ◽

Bullous Keratopathy ◽

Minimally Invasive Techniques ◽

Endothelial Keratoplasty ◽

Case Histories ◽

Pars Plana ◽

Invasive Techniques

We report here three patients who underwent combined Descemet’s stripping with endothelial keratoplasty and transconjunctival pars plana vitrectomy for bullous keratopathy and posterior segment pathology. A surgical technique and case histories are described. Anatomic and visual outcomes of combined Descemet’s stripping with endothelial keratoplasty and vitrectomy were excellent. Our experience provides technical guidelines and limitations. The combined minimally invasive techniques allow for rapid anatomical recovery and return of function and visual acuity in a single sitting.

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Double-Glide Method Using Cathereep Protective Sheet As a Substitute in Descemet's Stripping Automated Endothelial Keratoplasty

ISRN Transplantation ◽

10.5402/2013/713153 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

Hiroshi Toshida ◽

Rio Honda ◽

Asaki Matsui ◽

Yusuke Matsuzaki ◽

Yusuke Shimizu ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Perioperative Complications ◽

Endothelial Damage ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Postoperative Course ◽

Polyurethane Film ◽

Donor Graft ◽

Graft Insertion

Purpose. For the insertion of the donor graft in Descemet's stripping automated endothelial keratoplasty (DSAEK), the double-glide method using a Busin glide and intraocular lens (IOL) glide concomitantly has been shown to be effective. The aim of this report is to evaluate the results for the double-glide method using Cathereep (Nichiban, Tokyo, Japan), a protective sheet made of polyurethane film for medical use, as a substitute for an IOL glide. Materials and Methods. The subjects were 10 eyes of 10 patients with bullous keratopathy. The DSAEK operation was performed, and the double-glide method was used for the donor graft insertion. During the operation, an IOL glide was used for the 5 eyes, and the Cathereep protection sheet was used for the remaining 5 eyes. We trimmed approximately 5 mm wide strips from the nonadhesive area surrounding the Cathereep protection sheet. Results. The donor graft was inserted equally easily with the Cathereep protective sheet and IOL glides and improvement of visual acuity was noted in both groups significantly. A favorable postoperative course was obtained with no perioperative complications including endothelial damage. Conclusions. Cathereep protective sheet can be used as a substitute for an IOL glide for double-glide method in DSAEK.

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Clinical outcomes of pre-loaded ultra-thin DSAEK and pre-loaded DMEK

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2020-000546 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000546

Author(s):

Vito Romano ◽

Luca Pagano ◽

Kunal A Gadhvi ◽

Giulia Coco ◽

Mitchell Titley ◽

...

Keyword(s):

Visual Acuity ◽

Clinical Outcomes ◽

Corneal Dystrophy ◽

University Hospital ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Corrected Visual Acuity ◽

Pseudophakic Bullous Keratopathy ◽

Best Corrected Visual Acuity

ObjectiveTo compare clinical outcomes and complications between pre-loaded ultra-thin Descemet stripping automated endothelialkeratoplasty (pl-UT-DSAEK) and pre-loaded Descemet membrane endothelial keratoplasty (pl-DMEK).Methods and analysisComparative study in patients with endothelial dysfunction associated with Fuchs endothelial corneal dystrophy and pseudophakic bullous keratopathy who underwent pl-UT-DSAEK or pl-DMEK transplants. For both groups, the tissues were pre-loaded at the Fondazione Banca degli Occhi del Veneto (Venice, Italy) and shipped to The Royal Liverpool University Hospital (Liverpool, UK). Best corrected visual acuity (BCVA) and re-bubbling rates were the main outcome measures.Results56 eyes of 56 patients were included. 31 received pl-UT-DSAEK and 25 received pl-DMEK. At 12 months, BCVA (LogMAR) was significantly better for pl-DMEK (0.17±0.20 LogMAR) compared with pl-UT-DSAEK (0.37±0.37 LogMAR, p<0.01). The percentage of people that achieved ≥20/30 was significantly higher in the pl-DMEK group. The rate of re-bubbling, however, was significantly higher for pl-DMEK (44.0%) than for Pl-UT-DSAEK (12.9%), p<0.01.ConclusionPl-DMEK offers better BCVA than pl-UT-DSAEK. The higher re-bubbling rate associated with pre-loaded DMEK is of concern.

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Evaluation of Donor and Recipient Characteristics Involved in Descemet Stripping Automated Endothelial Keratoplasty Outcomes

Frontiers in Medicine ◽

10.3389/fmed.2021.605160 ◽

2021 ◽

Vol 8 ◽

Author(s):

Michele Lanza ◽

Rosa Boccia ◽

Adriano Ruggiero ◽

Paolo Melillo ◽

Mario Bifani Sconocchia ◽

...

Keyword(s):

Diabetes Mellitus ◽

Visual Acuity ◽

Central Corneal Thickness ◽

Corneal Thickness ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Eye Bank ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Aims: To evaluate both donor and recipient features involved in visual acuity restoring and complication insurgence in eyes that have undergone Descemet stripping automated endothelial keratoplasty (DSAEK).Methods: In this retrospective study, charts of 111 eyes of 96 patients (mean age 70.25 ± 8.58 years) that underwent DSAEK were evaluated. Only Fuch's Distrophy (FD) or Bullous Keratopathy (BK) due to cataract surgery eyes were included. A complete ophthalmic check with endothelial cell density (ECD) and central corneal thickness (CCT) measurement was performed before surgery and at 1, 3, 6, and 12 months follow-up. Each DSAEK was performed by the same well-trained surgeon; only pre-cut lenticules, provided by same Eye Bank, were implanted.Results: A total of 48 (43%) complications have been observed (most of them were 22 partial graft detachments and 17 IOP spikes). At the last follow-up (mean: 8.58 ± 4.09 months), a significant increase (p < 0.05) of best corrected visual acuity (BCVA) was detected. Overall mean BCVA of the eyes evaluated was 0.40 ± 0.43 LogMAR with BK eyes showing a significantly higher improvement (p < 0.05) compared to FD eyes. The only factor showing a significant correlation (p < 0.05) with visual acuity enhancement was the implant of a lenticule thinner than 100 μm. Recipient features significantly (p < 0.05) associated with complications observed after surgery were glaucoma and diabetes mellitus.Conclusion: The use of a graft thinner than 100 μm can provide better visual acuity recovery while recipients affected by glaucoma or diabetes mellitus are more prone to develop complications after surgery.

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Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211027705 ◽

2021 ◽

Vol 13 ◽

pp. 251584142110277

Author(s):

Zahra Ashena ◽

Thomas Hickman-Casey ◽

Mayank A. Nanavaty

Keyword(s):

Visual Acuity ◽

Penetrating Keratoplasty ◽

Anterior Segment ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Ocular Coherence Tomography ◽

Corrected Visual Acuity ◽

Intracameral Injection ◽

History Of

A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

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