Descemet Membrane Endothelial Keratoplasty in Toxic Anterior Segment Syndrome

Cornea ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kara Necip ◽  
Refik Oltulu ◽  
Dogan Levent ◽  
Gundogan Ali Osman
Keyword(s):  
Anterior Segment ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Toxic Anterior Segment Syndrome

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

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.

Epithelial downgrowth after Descemet membrane endothelial keratoplasty

2020 ◽  
pp. 112067212091241
Author(s):  
Viet Nhat Hung Le ◽  
Florian Wabnig ◽  
Bjoern Bachmann ◽  
Claus Cursiefen
Keyword(s):  
Anterior Segment ◽  
Corneal Edema ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Visual Axis ◽  
Corneal Incision ◽  
Descemet Membrane ◽  
Clear Corneal Incision ◽  
Close Observation ◽  
Histopathologic Evaluation

Purpose: To describe a patient with epithelial downgrowth after Descemet membrane endothelial keratoplasty. Methods: Case report. Results: A 73-year-old woman underwent triple Descemet stripping automated endothelial keratoplasty for cataract and corneal edema secondary to Fuchs endothelial dystrophy in the left eye elsewhere. Three years later, Descemet membrane endothelial keratoplasty was performed at our department due to graft failure. One month after the operation, her vision improved to 20/32 and maintained stable. At the 14-month visit, her visual acuity decreased, and a routine examination revealed epithelial downgrowth at the posterior surface of the cornea and partly beneath the graft, accompanied by presumed graft rejection. Therefore, repeat Descemet membrane endothelial keratoplasty with epithelial scraping and intracameral injection of 5-fluorouracil was indicated. She recovered 20/25 vision by 1 month after the surgery. However, small sheet-like epithelial downgrowth recurred 1 month later. The epithelial downgrowth was limited to the peripheral margin of the Descemet membrane endothelial keratoplasty graft and did not affect the visual axis. Epithelial downgrowth showed “islands” with connection between epithelial downgrowth and clear corneal incision on anterior segment optical coherence tomography images. Histopathologic evaluation of the removed Descemet membrane endothelial keratoplasty graft confirmed conjunctival epithelium as the source. Under close observation at the current 4-year follow-up, the epithelial downgrowth remained stable and localized and her vision increased to 20/20. Conclusion: Epithelial downgrowth can occur after Descemet membrane endothelial keratoplasty. The limited progression of epithelial downgrowth in this patient suggests that this condition after Descemet membrane endothelial keratoplasty even in the recurrence stage may cause less damage than expected and may only need to be observed closely if no progression occurs.

Anterior segment reconstruction with artificial iris and Descemet membrane endothelial keratoplasty: a staged surgical approach

2021 ◽  
pp. bjophthalmol-2020-317906
Author(s):  
Marcus Ang ◽  
Donald Tan
Keyword(s):  
Surgical Approach ◽  
Central Corneal Thickness ◽  
Intraoperative Complications ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Artificial Iris ◽  
Corneal Decompensation

PurposeTo describe a surgical approach that involves anterior segment reconstruction with CustomFlex Artificial Iris (CAI; HumanOptics, Erlangen, Germany) followed by Descemet membrane endothelial keratoplasty (DMEK) in complex eyes with corneal decompensation.MethodsRestrospective case series of eyes that underwent anterior segment restoration involving (1) synechiolysis of peripheral anterior synechiae and excision of iris remnants, (2) securing a well-fixated posterior chamber intraocular lens and (3) suture-fixated or capsular bag placement of CAI. All eyes then underwent DMEK using a pull-through technique with the DMEK EndoGlide (Network Medical Products, Ripon, UK). Main outcomes were successful anterior segment restoration and corneal clarity with central corneal thickness (CCT).ResultsFive eyes of five patients (median age 61 years, range 27–69 years; 60% female) underwent anterior segment reconstruction with CAI implantation (4 suture-fixated), followed by successful DMEK surgery (median 2 months later, range 1–5 months). There were no major intraoperative complications or primary graft failure, with one peripheral graft detachment that underwent a successful re-bubble at 1 week. All eyes had stable CAI implants and DMEK grafts remained clear at last follow-up with reduction in mean central corneal thickness (preoperative: 658±86 µm vs postoperative: 470±33 µm, p=0.005).ConclusionThis pilot study highlights a feasible approach of initial anterior segment reconstruction with CAI implantation, prior to DMEK, in eyes with significant anterior segment abnormalities such as iris damage or extensive peripheral anterior synechiae and corneal decompensation.

scholarly journals Preoperative Evaluation in Descemet Membrane Endothelial Keratoplasty for Secondary Penetrating Keratoplasty Graft Failure

2020 ◽  
Author(s):  
Khaled Safadi ◽  
Ron Kaufman ◽  
Eleanor Nche ◽  
Denise Wajnsztajn ◽  
Itay Lavy
Keyword(s):  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Medical Center ◽  
Preoperative Evaluation ◽  
Anterior Segment ◽  
P Value ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane

Abstract Background: Over the past decade, Penetrating Keratoplasty (PKP) graft failure has been increasingly managed by Descemet Membrane Endothelial Keratoplasty (DMEK). Our aim is to emphasis the importance of preoperative evaluation by Anterior-Segment Optical Coherence Tomography (AS-OCT) and present the clinical outcomes and surgical modifications of DMEK performed for Secondary PKP graft failure.Methods: A retrospective medical records review of patients that underwent DMEK for failed PKP at Hadassah Medical Center in 2018-2019. Collected data included demographic characteristics, PKP graft size measured by AS-OCT, corneal donor endothelial cell density (ECD), intra-operative surgical method adjustments, post-operative complications, visual acuity in Snellen (VA), central pachymetry and post-operative ECD.Results: Included were 16 patients (9 males) and 16 eyes. The study period was 18 months. Mean age at performing DMEK was 63 years. Before DMEK, mean VA and central pachymetry were 0.04 and 685µm, respectively. At last follow up, they significantly improved to 0.3 (p-value=0.001) and 542µm (p-value=0.008) respectively. Mean ECD for donor grafts was 2662 cells per mm2. Post-operative ECD was available only for 7 cases with a mean of 1391 cells per mm2 (p-value=0.0002). At last follow up, 93.75% of the grafts were attached. Graft failure rate was 6.25% due to late decompensation, graft detachment rate and rebubbling rate were 18.75% respectively. Conclusion: A suitable case-based pre-operative evaluation by AS-OCT may play a vital role in DMEK for failed PKP. No less important is to take into consideration multiple surgical adjustments. Both may further decrease complications rates along with accelerating visual recovery.

scholarly journals Descemet Membrane Endothelial Keratoplasty: Intraoperative and Postoperative Imaging Spectral-Domain Optical Coherence Tomography

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Marcus Ang ◽  
Adam M. Dubis ◽  
Mark R. Wilkins
Keyword(s):  
Optical Coherence Tomography ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Spectral Domain ◽  
Optical Coherence ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Postoperative Imaging ◽  
Initial Adhesion

We describe a case report of using the same handheld spectral-domain anterior segment optical coherence tomography (ASOCT) for rapid intraoperative and postoperative imaging in a case of Descemet membrane endothelial keratoplasty (DMEK). A 67-year-old woman, with Fuchs dystrophy and corneal decompensation, underwent DMEK with intraoperative ASOCT imaging using the handheld Envisu spectral domain ASOCT system (Bioptigen, Inc., Morrisville, NC, USA). We found that this easy-to-use portable system with handheld probe allowed for rapid imaging of the anterior segment during donor manipulation to visualize the orientation of the DMEK donor, as well as to confirm the initial adhesion of the DMEK donor. Moreover, the same system may be used for postoperative monitoring of graft adhesion, corneal thickness, and stromal remodeling in the clinic with very high-definition images.

scholarly journals Risk Factors for Cystoid Macular Edema After Descemet Membrane Endothelial Keratoplasty

Cornea ◽  
2019 ◽  
Vol 38 (7) ◽  
pp. 820-824 ◽  
Author(s):  
Satoru Inoda ◽  
Takahiko Hayashi ◽  
Hidenori Takahashi ◽  
Itaru Oyakawa ◽  
Hideaki Yokogawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Macular Edema ◽  
Cystoid Macular Edema ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane
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