A Case of Descemet’s Membrane Endothelial Keratoplasty in a failed Penetrating Keratoplasty

Background: Descemet’s membrane endothelial keratoplasty (DMEK) is an evolving option for failed penetrating keratoplasty (PK) as it has shown promising results compared to repeat PK. Case description: A 22 years young gentleman presented with gradual diminution of vision in the left eye (LE) for six months following therapeutic PK for a perforated fungal corneal ulcer. His best spectacle corrected visual acuity (BSCVA) was 6/60 in LE. Slit-lamp examination of LE revealed circumcorneal congestion with full thickness corneal graft with micro and macrobullae, diffuse stromal edema, DM folds and seven well-buried sutures. Intraocular pressure was 20 mmHg in the right eye whereas it could not be assessed in the left eye. The diagnosis of LE failed PK was made and the patient underwent DMEK. At four months postoperative follow up visit, BSCVA improved to 6/9. This is the first reported case of DMEK after a failed PK in a young patient from Nepal which was successfully treated without any complications. Conclusion: DMEK has a higher potential for better visual rehabilitation compared to DSEK and PK. It has also proved its efficacy in the treatment of endothelial graft failure following PK as it is a less invasive procedure.

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Descemet’s Stripping Automated Endothelial Keratoplasty versus Descemet’s Membrane Endothelial Keratoplasty in the Fellow Eye for Fuchs Endothelial Dystrophy: A Retrospective Study

BioMed Research International ◽

10.1155/2015/750567 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 19

Author(s):

Vipul Bhandari ◽

Jagdeesh K. Reddy ◽

Kirti Relekar ◽

Vijayalakshmi Prabhu

Keyword(s):

Case Series ◽

Visual Outcome ◽

Endothelial Keratoplasty ◽

Fellow Eye ◽

Descemet’S Membrane Endothelial Keratoplasty ◽

Descemet's Membrane ◽

Descemet’S Membrane ◽

Fuchs Endothelial Dystrophy ◽

Fellow Eyes

Aim. To evaluate visual outcome and endothelial cell density (ECD) after Descemet’s Membrane Endothelial Keratoplasty (DMEK) in comparison with Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) in the fellow eye for Fuchs endothelial dystrophy (FED).Design. Single-centre, retrospective case series.Methods. 30 eyes of 30 patients undergoing DMEK, who completed a 1-year follow-up, were compared with 30 fellow eyes which underwent DSAEK for bilateral FED. Main outcome measures studied included Best Corrected Visual Acuity (BCVA) and ECD during a 1-year follow-up period.Results. BCVA improved from 0.78 ± 0.35 logMAR, and 0.73 ± 0.31 logMAR before surgery to 0.22 ± 0.1 logMAR and 0.35 ± 0.12 logMAR 6 months after DMEK and DSEK, respectively (P<0.001). At one year after surgery, the BCVA was maintained at 0.21 ± 0.12 logMAR and 0.34 ± 0.1 logMAR, respectively, after DMEK and DSAEK. A statistically better visual outcome was observed after DMEK compared to DSAEK (P<0.05) in fellow eyes.Conclusions. DMEK provided better visual rehabilitation when compared to DSAEK. Nevertheless, there were no significant differences with regard to the ECD within a 1-year follow-up.

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Corneal pachymetry by AS-OCT after Descemet’s membrane endothelial keratoplasty

Scientific Reports ◽

10.1038/s41598-021-93186-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Friso G. Heslinga ◽

Ruben T. Lucassen ◽

Myrthe A. van den Berg ◽

Luuk van der Hoek ◽

Josien P. W. Pluim ◽

...

Keyword(s):

Deep Learning ◽

Endothelial Function ◽

Corneal Thickness ◽

Anterior Segment ◽

Anatomical Landmarks ◽

Endothelial Keratoplasty ◽

Descemet’S Membrane Endothelial Keratoplasty ◽

Descemet's Membrane ◽

Descemet’S Membrane ◽

Thickness Measurements

AbstractCorneal thickness (pachymetry) maps can be used to monitor restoration of corneal endothelial function, for example after Descemet’s membrane endothelial keratoplasty (DMEK). Automated delineation of the corneal interfaces in anterior segment optical coherence tomography (AS-OCT) can be challenging for corneas that are irregularly shaped due to pathology, or as a consequence of surgery, leading to incorrect thickness measurements. In this research, deep learning is used to automatically delineate the corneal interfaces and measure corneal thickness with high accuracy in post-DMEK AS-OCT B-scans. Three different deep learning strategies were developed based on 960 B-scans from 50 patients. On an independent test set of 320 B-scans, corneal thickness could be measured with an error of 13.98 to 15.50 μm for the central 9 mm range, which is less than 3% of the average corneal thickness. The accurate thickness measurements were used to construct detailed pachymetry maps. Moreover, follow-up scans could be registered based on anatomical landmarks to obtain differential pachymetry maps. These maps may enable a more comprehensive understanding of the restoration of the endothelial function after DMEK, where thickness often varies throughout different regions of the cornea, and subsequently contribute to a standardized postoperative regime.

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