Results of posterior lamellar femto-keratoplasty using two different lasers

Purpose. To evaluate the results of treatment of patients with pseudophakic bullous keratopathy (PBK) by the method of posterior lamellar femto-keratoplasty with ultrathin graft (FS-DSEK) harvested using two different lasers. Material and methods. The results of surgical treatment of 82 patients (82 eyes) underwent posterior lamellar femto-keratoplasty for PBK were analyzed. In the 1st group included 43 patients (43 eyes) with PBK underwent FS-DSEK using FS laser Femto-Visum (Optosystems, Russia). In the 2nd group included 39 patients (39 eyes) with PBK underwent FS-DSEK using LDV Z8 (Ziemer, Switzerland). Observation period was 1 year. Before and after surgery following indicators were evaluated: uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), postoperative astigmatism, central corneal thickness (CCT), graft thickness, center-periphery (C:P) ratio, endothelial cell density (ECD), endothelial cell (EC) loss, optical density. Results. Transparent engraftment at 1-year observation period was observed in 88% of cases. In the 1st group UCVA=0.22±0.11, BSCVA=0.32±0.12, in the 2nd group UCVA=0.18±0.08, BSCVA=0.29±0.1 (p>0.05). The maximum BSCVA in both groups was 0.6. Postoperative astigmatism was comparative in 2nd groups – 1.43±1.1 and 1.38±1.0 D, respectively (p>0.05). In the 1st group, CCT=549±31, graft thickness in the central zone – 83±12, C:P ratio – 0.92±0.05; in the 2nd group CCT=546±28, graft thickness – 80±10, C:P ratio – 0.94±0.06 (p>0.05). In the 1st group ECD – 1326±282, EC loss – 55±6%; ECD in the 2nd – 850±230, EC loss – 70±7% (p<0.05). According to the results of densitometry, optical density of the posterior layers of the cornea and «donor–recipient» interface zone was higher in the 2nd group, both in the central and in the paracentral zones: in the 1st group in the posterior layers of the stroma – 16.4±1.2 (0–2 mm) and 15.8±1.0 (2–6 mm), in the interface zone – 14.5±0.9 (0–2) and 13.9±0.8 (2–6), in the 2nd group in the posterior layers – 18.3±1.3 (0–2 mm) and 17.9±1.1 (2–6 mm), and in the interface zone – 17.3±1.2 (0–2 mm) and 17.0±1.0 (2–6 mm, p<0.05). Conclusions. FS-DSEK showed high efficiency for treating patients with PBK. Functional results were comparative in 2nd groups. Statistical analysis showed highest safety of transplanted endothelium in the 1st group at 1-year observation period. Key words: pseudophakic bullous keratopathy, femtosecond laser, posterior lamellar keratoplasty, corneal endotheliumultrathin graft.

Was it thickened Dua’s layer? Clinical, tomographical, and histopathological correlation: A case report

A 62-year-old female developed pseudophakic bullous keratopathy after cataract surgery and underwent Descemet stripping automated endothelial keratoplasty (DSAEK). Intraoperatively, a white opacified pre-Descemet’s layer was noticed after scoring and removal of trypan blue stained Descemet’s membrane (DM), and endothelium complex. It was removed using internal limiting membrane peeling forceps and sent for histopathological evaluation along with DM-endothelium complex and epithelium. Preoperative, intraoperative, and postoperative clinical, tomographical, and histopathological data confirmed thickened PDL or Dua’s layer. This is a rare encounter with scarred PDL or Dua’s layer during DSAEK surgery.

Exophiala Keratitis following Descemet Stripping Automated Endothelial Keratoplasty

Purpose. To report a case with Exophiala spp. keratitis in a Portuguese patient. Methods. A case report with deep corneal brown-pigmented infiltrates that developed 2 months after a Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) for pseudophakic bullous keratopathy. Results. Diagnosis was established by positive direct examination and cultures from the surgically obtained corneal button. Slit-lamp images and anterior segment optical coherence tomography (AS-OCT) scans were obtained. Conclusion. This is the first described case of fungal keratitis caused by Exophiala spp. in Portugal and, to our knowledge, the first case following DSAEK in the literature.

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

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.

A peculiar case of corneal autograft in a patient with bilateral advanced glaucoma

The technique of autograft employs the use of a clear corneal graft from an otherwise blind eye that is transplanted to the fellow eye, which has a visual potential in the same patient. A patient with advanced glaucoma in both eyes presented to us with pseudophakic bullous keratopathy with Ahmed glaucoma valve in the right eye, and cataract and patent peripheral iridotomy with no perception of light in the left eye. The autograft and allograft corneas for bilateral penetrating keratoplasty (PK) were obtained from the contralateral eye and a cadaver eye, respectively. Central corneal button was used for PK. One year after the surgery, the graft host junction was well apposed with no vascularization, corneal surface was clear, sutures were intact, and best corrected visual acuity improved in right eye to 1 logMAR. Bilateral simultaneous PK with autograft in one eye and allograft in the other was done to decrease the chances of rejection.