Corneal Imaging and Densitometry Measurements in Patients with Fuchs' Dystrophy Undergoing Penetrating Keratoplasty and Descemet's Striping Automated Endothelial Keratoplasty

Abstract Aims:In the present study, we used the densitometry software from the Oculus Pentacam to compare postoperative corneal clarity between penetrating keratoplasty (PK) and Descemet's stripping endothelial keratoplasty (DSAEK) in patients with Fuchs' dystrophy.Methods:A retrospective comparative study was carried out at Manchester Royal Eye Hospital. In 28 patients with Fuchs' dystrophy, corneal densitometry measurements were performed 12–18 months after corneal transplantation. The correlations of the densitometry measurements with the best corrected visual acuity (BCVA) and central corneal thickness (CCT) were analysed and compared between eyes that underwent PK and those that underwent DSAEKResults:Corneal densitometry measurements in the 33 eyes showed no significant differences between the PK and DSAEK post-surgery groups. There was no significant correlation between CCT and corneal densitometry measurements in either group (P > 0.05 in both cases). After DSAEK, corneal densitometry measurements were significantly correlated with BCVA in the central (P = 0.01), posterior (P = 0.007), and full-depth (P = 0.008) 0–2 mm zones of the cornea but not in PK group. The postoperative CCT was significantly different between the two groups (P˂0.01).Conclusion:The two types of corneal transplantation resulted in different outcomes in terms of corneal densitometry measurements. Improved visual acuity after DSAEK was found to positively correlate with improvements in corneal clarity. Oculus Pentacam provides an objective evaluation tool to monitor corneal status after surgery.

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Simultaneous phacoemulsification, lens implantation and endothelial keratoplasty: Triple procedure

Vojnosanitetski pregled ◽

10.2298/vsp1109800n ◽

2011 ◽

Vol 68 (9) ◽

pp. 800-803

Author(s):

Ljubisa Nikolic ◽

Vesna Jovanovic

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Corneal Thickness ◽

Good Choice ◽

Endothelial Keratoplasty ◽

Finger Counting ◽

Triple Procedure ◽

Lens Implantation ◽

Lens Power ◽

Fuchs Dystrophy

Introduction. Simultaneous Descemet stripping endothelial keratoplasty, phacoemulsification, and intraocular lens implantation are indicated in Fuchs? dystrophy with associated cataract. Compared to the standard method of the triple procedure which includes penetrating keratoplasty, this new method has the advantages of sutureless surgery, small limbal incision, faster recovery, less surface problems, less astigmatism, stronger tensile strength and more predictable calculation of the intraocular lens power. This is the first report of such a combination of procedures in our literature. Case report. A 76-year-old woman suffered from a gradual bilateral visual loss. The best corrected visual acuity was 20/60 (right eye) and finger counting at 1m (left eye). Corneal thickness was 590 ?m and 603 ?m, respectively. A marked cornea guttata and nuclear cataract were present in both eyes. Phacoemulsification, lens implantation, and Descemet stripping were done in the left eye. The posterior lamellar corneal graft, 8.0 mm in diameter and about 150 ?m thick, was bent and inserted through the limbal incision. The air was injected into the anterior chamber to attach the graft to the recipient stroma. The cornea remained clear, and the transplant was attached during a two-year follow-up. Visual acuity was 20/40 after two months, and 20/25 after one year. Conclusion. The new technique proved itself as a good choice for the treatment of a mild Fuchs? dystrophy associated with cataract.

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Kinetics of Tear Fluid Proteins after Endothelial Keratoplasty and Predictive Factors for Recovery from Corneal Haze

Journal of Clinical Medicine ◽

10.3390/jcm9010063 ◽

2019 ◽

Vol 9 (1) ◽

pp. 63

Author(s):

Nobuyo Yawata ◽

Sunita Awate ◽

Yu-Chi Liu ◽

Shi Yuan ◽

Kaing Woon ◽

...

Keyword(s):

Visual Acuity ◽

Healing Process ◽

Corneal Transplantation ◽

Cytokine Expression ◽

Tear Fluid ◽

Endothelial Keratoplasty ◽

Tear Proteins ◽

Corneal Haze ◽

Post Surgery ◽

Group 1

Endothelial keratoplasty (EK) is less invasive with faster recovery as compared to conventional penetrating keratoplasty, however, it relies on the clarity of the host corneal stroma. Corneal transplantation involves the induction of immune tolerance for allogeneic tissues as well as the corneal wound healing process, in which coordinated interactions between cytokines and growth factors are critical. In this study, we profiled the expression of 51 soluble factors in the tear fluid over the course of EK and have provided evidence of dynamic changes in cytokine expression in the ipsilateral and contralateral eyes. Cluster analyses classified the cytokine expression kinetics into five groups. Group 1 proteins included TGF-b1, IL-1b, and innate proinflammatory cytokines, which bilaterally increased after surgery, despite the use of topical corticosteroid in the transplanted eyes. Local corticosteroids suppressed cytokines involved in adaptive immunity in the transplanted eyes but not in the contralateral eyes. We found tear protein expression at baseline and one week post-surgery to be a potential predictive biomarker of delayed recovery after EK in terms of the corneal haze and visual acuity. Furthermore, Group 1 tear proteins were most associated with persistent corneal haze pre-surgery as well as visual acuity at one month-post transplant.

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THE PARTIAL DISCEMETOREXIS WITHOUT TRANSPLANTATION IN CASE OF ENDOTHELIAL DYSTROPHY OF CORNEA

Medical Journal of the Russian Federation ◽

10.18821/0869-2106-2017-23-6-302-307 ◽

2017 ◽

Vol 23 (6) ◽

pp. 302-307

Author(s):

Oganes G. Oganesyan ◽

A. A Grdikanyan ◽

S. S Yakovleva ◽

V. R Getadaryan

Keyword(s):

Endothelial Cells ◽

Visual Acuity ◽

Optical Density ◽

Penetrating Keratoplasty ◽

Crystalline Lens ◽

Lamellar Keratoplasty ◽

Endothelial Keratoplasty ◽

Clinical Observations ◽

Fuchs Dystrophy ◽

Research Institute

During the last 20 years, the penetrating keratoplasty gave in its leading place to selective lamellar keratoplasty when pathologically altered layers of cornea are selectively replaced, including endothelium. The main technical task of all procedures of endothelial keratoplasty is an obligatory complete or almost complete post-operative adjacency of endothelial transplant to stroma of recipient. However, there are publications concerning resorption of edema in case of separation of endothelial transplant and even at its absence. The purpose of study. To analyze, on the basis of limited clinical observations, the results of partial discemetorexis (5.25 mm) without transplantation in patients with endothelial dystrophy of cornea (Fuchs).The materials and methods. The study was implemented concerning maximal correcting visual acuity, central thickness of cornea, density of endothelial cells and optical density of cornea, before, in one day, in one week, in 1, 3 and every 6 months after operation. The study covered 6 patients with Fuchs dystrophy (average age 63 ± 6,5 years) operated in 2015-2016 with period of observation neither less than 6 months. The visual acuity before operation in average made up to 0,32 ± 017 mkm, average central thickness of cornea - 677 ± 76 mkm. The native crystalline lens was present in 2 patients. The study was supported by ethical committee of the Helmholtz Moscow research institute of eyes diseases. The results. The resorption of edema of cornea occurred in 2 patients (33%), visual acuity increased from 0.45 to 0.6. In different periods density of endothelial cells varied from 549 to 689 kl/mm2. The central thickness of cornea decreased from 613 ± 33 mkm to 553 ± 15 mkm in 12 months after operation. Conclusion. The discemetorexis (5.25 mm) is more often efficient in case of availability of native crystalline lens, at earlier stages of dystrophy independently of patient's age. The discemetorexis ensures lower indices of maximal correcting visual acuity and density of endothelial cells and higher values of central thickness of cornea in comparison with DMEK. The indices of central thickness of cornea and optical density of cornea are exposed to fluctuations in different periods after discemetorexis (5.25 mm).

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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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Refractive outcome and tomographic changes after Descemet membrane endothelial keratoplasty in pseudophakic eyes with Fuchs’ endothelial dystrophy

International Ophthalmology ◽

10.1007/s10792-021-01850-w ◽

2021 ◽

Author(s):

Bishr Agha ◽

Nura Ahmad ◽

Daniel G. Dawson ◽

Thomas Kohnen ◽

Ingo Schmack

Keyword(s):

Central Corneal Thickness ◽

Corneal Thickness ◽

Corneal Astigmatism ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Corneal Densitometry ◽

Scheimpflug Imaging ◽

Fuchs Endothelial Dystrophy ◽

Posterior Corneal Astigmatism

Abstract Purpose To analyze refractive and topographic changes secondary to Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes with Fuchs’ endothelial dystrophy (FED). Methods Eighty-seven pseudophakic eyes of 74 patients who underwent subsequent DMEK surgery for corneal endothelial decompensation and associated visual impairment were included. Median post-operative follow-up time was 12 months (range: 3–26 months). Main outcome measures were pre- and post-operative manifest refraction, anterior and posterior corneal astigmatism, simulated keratometry (CASimK) and Q value obtained by Scheimpflug imaging. Secondary outcome measures included corrected distance visual acuity (CDVA), central corneal densitometry, central corneal thickness, corneal volume (CV), anterior chamber volume (ACV) and anterior chamber depth (ACD). Results After DMEK surgery, mean pre-operative spherical equivalent (± SD) changed from + 0.04 ± 1.73 D to + 0.37 ± 1.30 D post-operatively (p = 0.06). CDVA, proportion of emmetropic eyes, ACV and ACD increased significantly during follow-up. There was also a significant decrease in posterior corneal astigmatism, central corneal densitometry, central corneal thickness and corneal volume over time (p = 0.001). Only anterior corneal astigmatism and simulated keratometry (CASimK) remained fairly stable after DMEK. Conclusion Despite tendencies toward a hyperopic shift, changes in SE were not significant and refraction remained overall stable in pseudophakic patients undergoing DMEK for FED. Analysis of corneal parameters by Scheimpflug imaging mainly revealed changes in posterior corneal astigmatism pointing out the relevance of posterior corneal profile changes during edema resolution after DMEK.

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Primary surgical options for acute corneal hydrops: A review

European Journal of Ophthalmology ◽

10.1177/11206721211037833 ◽

2021 ◽

pp. 112067212110378

Author(s):

Gonzalo García de Oteyza ◽

Guido Bregliano ◽

Irene Sassot ◽

Luis Quintana ◽

Carolina Rius ◽

...

Keyword(s):

Visual Acuity ◽

Medical Therapy ◽

Penetrating Keratoplasty ◽

Corneal Transplantation ◽

Corneal Edema ◽

Self Healing ◽

Surgical Options ◽

Corneal Hydrops

Acute corneal hydrops usually resolves alone or with medical therapy along the first 4–6 weeks. However, depending on the severity of the corneal edema or the size of the Descemet break, self-healing might be difficult. Years ago, those patients had no more options than corneal transplantation, but surgical alternatives are on the rise in this century. These surgeries are becoming more popular with a variety of techniques relegating penetrating keratoplasty to a residual role. These techniques aim to accelerate corneal healing, reduce the edema, improve visual acuity and prevent from severe complications that may appear if corneal hydrops is not treated rapidly. Feasibility and safety are the favorable aspects of these techniques since the complications rates described remain low. In this review, we emphasize the recently published studies that describe both the techniques and their results.

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Visual acuity outcomes after Descmet’s stripping automated endothelial keratoplasty compared to penetrating keratoplasty

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2013.s034.x ◽

2013 ◽

Vol 91 ◽

pp. 0-0

Author(s):

ALI MOUNA ◽

S PREMY ◽

A AGAPIE ◽

A JEAN-COLAS ◽

F AMELOOT ◽

...

Keyword(s):

Visual Acuity ◽

Penetrating Keratoplasty ◽

Endothelial Keratoplasty

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A Case Report Illustrating the Postoperative Course of Descemetorhexis without Endothelial Keratoplasty with Topical Netarsudil Therapy

Case Reports in Ophthalmological Medicine ◽

10.1155/2019/6139026 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Pimpiroon Ploysangam ◽

Sangita P. Patel

Keyword(s):

Corneal Thickness ◽

Corneal Transplantation ◽

Corneal Dystrophy ◽

The United States ◽

Attractive Alternative ◽

Specular Microscopy ◽

Endothelial Keratoplasty ◽

Rock Inhibitor ◽

Data Set ◽

Microscopy Data

Fuchs endothelial corneal dystrophy (FECD) is the most common indication for corneal transplantation in the United States. Recently, descemetorhexis without endothelial keratoplasty (DWEK) or Descemet’s stripping only (DSO) has become an attractive alternative to corneal transplantation for these patients. DSO circumvents the challenges associated with cadaveric donor corneal transplantation by tapping into the potential of the patient’s own corneal endothelium to repair defects. Outcomes have been variable with emerging knowledge on predictive factors for success. Our case describes a 51-year-old patient with visually significant confluent central guttae from FECD who underwent a successful DSO with immediate post-operative use of the Rho-associated protein kinase (ROCK) inhibitor (netarsudil). We report the preoperative and post-operative slit lamp images, specular microscopy data, and corneal topography, thickness, and densitometry data. These represent a unique data set for this new surgical treatment option for FECD. Despite a small descemetorhexis, we show the improvement in corneal thickness and opacity extends beyond the boundaries of the descemetorhexis. Early initiation of a ROCK inhibitor was a successful treatment for this patient.

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