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

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.

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

2021 ◽  
Author(s):  
Khaled Alzahrani ◽  
Arun Brahma ◽  
Fiona Carley ◽  
M. Chantal Hillarby
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Corneal Thickness ◽  
Corneal Transplantation ◽  
Objective Evaluation ◽  
Endothelial Keratoplasty ◽  
Evaluation Tool ◽  
Corneal Densitometry ◽  
Post Surgery ◽  
Fuchs Dystrophy

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.

scholarly journals Descemet Membrane Endothelial Keratoplasty (DMEK) in Previously Vitrectomized Eyes: Complications and Clinical Outcomes

2021 ◽  
Author(s):  
Wissam Aljundi ◽  
Alaadin Abdin ◽  
Shady Suffo ◽  
Berthold Seitz ◽  
Loay Daas
Keyword(s):  
Corneal Thickness ◽  
Corneal Dystrophy ◽  
Control Group ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Group 2 ◽  
Postoperative Improvement ◽  
Group 1

Abstract Purpose To evaluate the results and complications of Descemet membrane endothelial keratoplasty (DMEK) in previously vitrectomized eyes. Design Retrospective study of 35 eyes that had undergone DMEK, due to Fuchs endothelial corneal dystrophy (FECD), at our department with a follow-up after 6 months postoperatively. We compared the intraoperative procedure, complications, and results of DMEK between 14 previously vitrectomized pseudophakic eyes (group 1) and a control group of 21 pseudophakic non-vitrectomized eyes (group 2). Results The unfolding time (in minutes) was significantly longer in group 1 than in group 2 (10.5 ± 6.4 vs. 3.2 ± 1.5, p < 0.01). A single re-bubbling was needed in 8 patients in group 1 (57.1%) and in 3 patients in group 2 (14.2%) (p < 0.01). Repeated re-bubbling (≥ 1 time) was performed in only 5 patients of group 1 (35.7%). There was significant postoperative improvement in best-corrected visual acuity (BCVA, in LogMAR) in both groups (p = 0.04 in group 1 and p < 0.01 in group 2). The central corneal thickness (CCT, in µm) did not differ significantly between the two groups preoperatively (p = 0.4) or postoperatively (p = 0.1). However, the CCT decreased significantly postoperatively in both groups (p < 0.01 in both groups). The postoperative endothelial cell density (ECD in cell/mm²) was significantly lower in group 1 than in group 2 (p = 0.03). Conclusion DMEK in previously vitrectomized eyes presents a surgical challenge, which requires special, and sometimes unpredictable, intraoperative maneuvers, but good functional and morphological results can be achieved. The use of the endothelial Descemet membrane lamellae (EDML) of older donors might be recommended to facilitate the intraoperative unfolding process.

Corneal transplantation trends in France from 2004 to 2015: A 12-year review

2018 ◽  
Vol 28 (5) ◽  
pp. 535-540 ◽  
Author(s):  
Guillaume Bigan ◽  
Marc Puyraveau ◽  
Maher Saleh ◽  
Philippe Gain ◽  
Isabelle Martinache ◽  
...  
Keyword(s):  
Penetrating Keratoplasty ◽  
Corneal Transplantation ◽  
Corneal Dystrophy ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Endothelial Keratoplasty ◽  
Surgical Indications ◽  
Anterior Lamellar Keratoplasty ◽  
Important Shift

Purpose: The aim of this study was to report the 12-year longitudinal trends in indication and corneal transplantation techniques in France from 2004 to 2015. Results: The records of all corneal transplantations performed from 2004 to 2015 in France were retrospectively reviewed. The patient indications and types of transplant performed were analyzed. A total of 46,658 corneal transplantations were performed between 2004 and 2015, with 34,187 (73.3%) penetrating keratoplasty and 10,452 (22.4%) lamellar keratoplasty. The leading surgical indications were secondary endothelial failure (24.3%), keratoconus (18.8%), regraft (13.5%), and Fuchs endothelial corneal dystrophy (15.1%). Endothelial keratoplasty became the preferred technique for endothelial diseases and deep anterior lamellar keratoplasty the preferred technique for keratoconus, surpassing penetrating keratoplasty in 2013. Conclusion: Secondary endothelial failure is the top indication for performing a keratoplasty over the 12-year period. There was a shift from penetrating keratoplasty to endothelial keratoplasty performed for Fuchs endothelial corneal dystrophy and secondary endothelial failure, and to deep anterior lamellar keratoplasty, performed for keratoconus. This highlights an important shift in managing corneal diseases toward the application of selective and more conservative surgeries and changes in indications in corneal transplantation.

scholarly journals Descemet’s Membrane Endothelial Keratoplasty for Pseudoexfoliation Syndrome: A Case Series

2019 ◽  
Author(s):  
Saho Tase ◽  
Toshiki Shimizu ◽  
Takahiko Hayashi ◽  
Hitoshi Tabuchi ◽  
Koji Niimi ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Corneal Thickness ◽  
Reduction Rate ◽  
Case Series ◽  
Corneal Dystrophy ◽  
Pseudoexfoliation Syndrome ◽  
Endothelial Keratoplasty ◽  
Descemet’S Membrane Endothelial Keratoplasty ◽  
Descemet's Membrane ◽  
Descemet’S Membrane

Abstract Bachground: To evaluate the clinical outcomes and features of Descemet’s membrane endothelial keratoplasty (DMEK) for eyes with pseudoexfoliation syndrome (PEX). Methods: In this retrospective study, 37 DMEK cases were reviewed from available medical records. Patients who exhibited endothelial dysfunction derived from PEX or Fuchs endothelial corneal dystrophy (FECD) and successfully underwent cataract surgery about four weeks before DMEK were enrolled. The best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD), and incidence of intra-operative/post-operative complications of DMEK were analyzed. Results: This study included 14 eyes of 14 patients (PEX: n=6, FECD: n=8). There was no primary graft failure. In the PEX group, BSCVA improved from 0.67 ± 0.28 at the preoperative point to 0.43 ± 0.14 at 1 month, 0.27 ± 0.10 at 3 months, and 0.19 ± 0.08 at 6 months after DMEK. The donor corneal ECD was 2,704 ± 225 cells/mm2 at the preoperative point and decreased to 1,691 ± 498 cells/mm2 at 1 month, 1,425 ± 366 cells/mm2 at 3 months, and 1,281 ± 340 cells/mm2 (52.7 ± 11.7% less than ECD of the donor graft) at 6 months after DMEK. None of the patients required rebubbling. When compared with the FECD group, no statistical difference was observed in CCT (p=0.821); BSCVA (p=0.001) and the reduction rate of ECD (p=0.010) were relatively worse. Conclusions: DMEK is effective for the treatment of endothelial dysfunction due to PEX.

scholarly journals Corneal Endothelial Cell Density and Morphology in Healthy Egyptian Eyes

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Marwa Mahmoud Abdellah ◽  
Hatem Gamal Ammar ◽  
Mohamed Anbar ◽  
Engy Mohammed Mostafa ◽  
Mahmoud Mohamed Farouk ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Cell Density ◽  
Corneal Thickness ◽  
Corneal Transplantation ◽  
Corneal Endothelial Cell ◽  
Endothelial Cell Density ◽  
Specular Microscopy ◽  
Cell Area ◽  
Corneal Endothelial Cell Density ◽  
The Mean

Purpose. To evaluate the corneal endothelial cell density and morphology in normal Egyptian eyes. Methods. In total, 568 healthy eyes of 568 Egyptian volunteers aged 20 to 85 years were examined using noncontact specular microscopy for the central corneal thickness (CCT), mean endothelial cell density (MCD), coefficient of variation (CV) in cell area, mean cell area (MCA), and hexagonal cell (Hex) percentage. Variables were compared between sexes and between different age groups. Results. The mean CCT, MCD, and MCA were 514.45 ± 43.04 μm, 2647.50 ± 382.62 cells/mm2, and 390.59 ± 149.94 μm2, respectively. MCD and MCA showed no significant differences between men and women (P=0.171 and 0.099, respectively), whereas CV (%) and Hex (%) showed significant differences (P=0.024 and 0.015, respectively). CCT (P=0.007, r = −0.113) and MCD (P<0.001, r = −0.357) exhibited a significant negative correlation with age, whereas CV (%) (P<0.001, r = 0.341) and MCA (P=0.008, r = 0.111) exhibited a significant positive correlation. The mean rate of endothelial cell loss from 20 to 85 years of age was 0.3% per year. Conclusions. Our results provide normative data for the corneal endothelium in healthy Egyptian eyes, thus increasing the knowledge base for corneal endothelial cell parameters in healthy Egyptian eyes. Furthermore, our findings can be used as baseline values for comparisons between Egyptian and other populations and for studies of the endothelial cell reserve and capacity for intraocular surgery and corneal transplantation.

scholarly journals Descemet’s Membrane Endothelial Keratoplasty for Pseudoexfoliation Syndrome: A Case Series

2019 ◽  
Author(s):  
Saho Tase ◽  
Toshiki Shimizu ◽  
Takahiko Hayashi ◽  
Hitoshi Tabuchi ◽  
Koji Niimi ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Corneal Thickness ◽  
Reduction Rate ◽  
Case Series ◽  
Corneal Dystrophy ◽  
Pseudoexfoliation Syndrome ◽  
Endothelial Keratoplasty ◽  
Descemet’S Membrane Endothelial Keratoplasty ◽  
Descemet's Membrane ◽  
Descemet’S Membrane

Abstract Background: To evaluate the clinical outcomes and features of Descemet’s membrane endothelial keratoplasty (DMEK) for eyes with pseudoexfoliation syndrome (PEX). Methods: In this retrospective study, 37 DMEK cases were reviewed from available medical records. Patients who exhibited endothelial dysfunction derived from PEX or Fuchs’ endothelial corneal dystrophy (FECD) and successfully underwent cataract surgery approximately four weeks before DMEK were enrolled. The best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD), and incidence of intra-operative/post-operative complications of DMEK were analyzed. Results: This study included 14 eyes of 14 patients (PEX: n=6, FECD: n=8). There was no primary graft failure. In the PEX group, BSCVA improved from 0.67 ± 0.28 preoperatively to 0.43 ± 0.14 at 1 month, 0.27 ± 0.10 at 3 months, and 0.19 ± 0.08 at 6 months after DMEK. The donor corneal ECD was 2,704 ± 225 cells/mm2 preoperatively and decreased to 1,691 ± 498 cells/mm2 at 1 month, 1,425 ± 366 cells/mm2 at 3 months, and 1,281 ± 340 cells/mm2 (52.7 ± 11.7% less than ECD of the donor graft) at 6 months after DMEK. None of the patients required rebubbling. When compared with the FECD group, no statistical difference was observed in CCT (p=0.821); BSCVA (p=0.001) and the reduction rate of ECD (p=0.010) were comparatively worse. Conclusions: DMEK is effective for the treatment of endothelial dysfunction due to PEX.

scholarly journals Evolving Therapies for Fuchs Endothelial Dystrophy

2018 ◽  
Vol 12 (1) ◽  
pp. 26
Author(s):  
Jodhbir Singh Mehta ◽  
Yu Qiang Soh ◽  
Viridiana Kocaba ◽  
◽  
◽  
...  
Keyword(s):  
Kinase Inhibitors ◽  
Corneal Transplantation ◽  
Rho Kinase ◽  
Corneal Dystrophy ◽  
Significant Shift ◽  
Endothelial Keratoplasty ◽  
Early Clinical Trial ◽  
Descemet Membrane ◽  
Rho Kinase Inhibitors ◽  
Fuchs Endothelial Dystrophy

Fuchs endothelial corneal dystrophy (FED) is one of the leading indications for corneal transplantation. Over the last two decades we have seen a significant shift in transplantation procedures for endothelial disease away from penetrating keratoplasty to small incision procedures such as Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty. More recently, even newer concepts have come to light to explore options of regenerative therapy for FED, e.g. Descemet stripping without endothelial keratoplasty, Descemet membrane transplantation and the use of adjuncts such as Rho kinase inhibitors. Furthermore, alternative strategies involving tissue engineering approaches with the use of cell therapy are also reaching early clinical trial stage. With more information on the underlying genetic abnormalities in FED, gene therapy may be a possible future treatment.

Refractive accuracy in eyes undergoing combined cataract extraction and Descemet membrane endothelial keratoplasty

2021 ◽  
pp. bjophthalmol-2020-317247
Author(s):  
Jack A Campbell ◽  
John G Ladas ◽  
Kendrick Wang ◽  
Fasika Woreta ◽  
Divya Srikumaran
Keyword(s):  
Corneal Thickness ◽  
Cataract Extraction ◽  
Absolute Error ◽  
Corneal Dystrophy ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Optical Biometry ◽  
Corneal Power ◽  
Descemet Membrane ◽  
The Difference

PurposeTo evaluate the refractive accuracy of current intraocular lens (IOL) formulas and propose a modification in calculation of corneal power in eyes undergoing combined cataract extraction and Descemet membrane endothelial keratoplasty (DMEK).DesignRetrospective cohort study.MethodsPatients with Fuchs endothelial corneal dystrophy undergoing uncomplicated combined cataract surgery and DMEK at a single institution were included. The Hoffer Q, SRK/T, Holladay I, Barrett Universal II and Haigis formulas were compared. A modified corneal power was calculated using a thick lens equation based on anterior and posterior corneal radii and corneal thickness from Pentacam imaging. Error calculations were adjusted based on the difference in optical biometry and the modified corneal power. Mean absolute error (MAE) for each formula was compared between the corneal power modification and optical biometry corneal power.ResultsIn 86 eyes, the mean error ranged from 0.90 D for the Barrett Universal II formula to −0.10 D for the Haigis formula, with 4 of 5 formulas resulting in a mean hyperopic error. The corneal power modification resulted in a significantly lower MAE for the Hoffer Q (0.82 D), Holladay I (0.85 D), SRK/T (0.85 D) and Barrett Universal II (0.90 D) formulas compared with optical biometry corneal power for the Hoffer Q (1.02 D; p<0.005), Holladay I (0.97 D; p<0.005), SRK/T (0.93 D; p<0.01) and Barrett Universal II (1.16 D; p<0.005) formulas.ConclusionsAll formulas except the Haigis formula resulted in a hyperopic error. The corneal power modification significantly reduced error in four out of five IOL formulas.

scholarly journals Demographic Profile and Clinical Course of Fuchs Endothelial Corneal Dystrophy in Mexican Patients.

2021 ◽  
Author(s):  
Maximiliano Barrera-Sanchez ◽  
Julio C. Hernandez-Camarena ◽  
Raul E. Ruiz-Lozano ◽  
Jorge E. Valdez-Garcia ◽  
Alejandro Rodriguez-Garcia
Keyword(s):  
Clinical Course ◽  
Clinical Stage ◽  
Corneal Transplantation ◽  
Corneal Dystrophy ◽  
Specular Microscopy ◽  
Slit Lamp ◽  
Male Ratio ◽  
Corrected Visual Acuity ◽  
Mexican Mestizo Population

Abstract Purpose To describe the demographic characteristics and clinical course of Fuchs endothelial corneal dystrophy (FECD) in a Mexican-mestizo population. Methods A retrospective observational and longitudinal study was performed in consecutive patients with the clinical diagnosis of Fuchs endothelial corneal dystrophy seen at our institution. Initial and last follow-up best corrected visual acuity, slit-lamp findings, and specular microscopy endothelial morphometric parameters were analyzed. Results One hundred and two eyes belonging to 51 patients were included in the analysis. Median age at the time of diagnosis was 69 years (range, 25–87 years) with a female-to-male ratio of 3.3:1. Visual loss (59.8%) and fluctuating matutine vision (7.8%) were the most common complaints at presentation. Regarding FECD staging, 65 (63.7%) were classified as stage-I FECD, 21 (20.6%) stage-II, and 15 (14.7%) as stage-III. A high percentage of eyes (44%) presented visual impairment (≤ 20/40) at presentation, and the presence of isolated corneal guttata was the most common stage of presentation (64%) at slit-lamp examination. Fifty-nine (57.8%) eyes did not require any medical or surgical management, and 17% of the evaluated eyes finally required a corneal transplantation, being penetrating keratoplasty with 8 (44.4%) eyes the most frequent technique performed. Conclusion Demographical characteristics of Fuchs dystrophy regarding age at presentation, gender distribution, and clinical stage at the time of diagnosis did not differ significantly from other international reports. Almost 20% of these patients will require keratoplasty during the disease, emphasizing the need for safer and more reproducible keratoplasty techniques.

scholarly journals Corneal Subbasal Plexus in Eyes with Fuchs’ Endothelial Corneal Dystrophy after Two Different Endothelial Surgeries

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Irene Abicca ◽  
Marta Gilardi ◽  
Daniela Giannini ◽  
Rossella Anna Maria Colabelli Gisoldi ◽  
Augusto Pocobelli ◽  
...  
Keyword(s):  
Corneal Thickness ◽  
Corneal Dystrophy ◽  
Nerve Fibers ◽  
Endothelial Keratoplasty ◽  
Chi Square ◽  
Corneal Incision ◽  
Corneal Confocal Microscopy ◽  
Corrected Distance Visual Acuity ◽  
Different Types

Purpose. To evaluate the morphological features and density of corneal subbasal plexus (SBP) using in vivo corneal confocal microscopy (IVCCM) in patients affected by Fuchs’ endothelial corneal dystrophy (FECD) six months after Descemet membrane endothelial keratoplasty (DMEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK). Methods. We included patients affected by FECD, requiring corneal endothelial surgery due to corneal oedema occurred from 3 to 6 months. 7 eyes underwent DMEK and 7 eyes DSAEK. All patients performed IVCCM preoperative and in six months postoperative. We analyzed SBP parameters, using CS4 Nerves Tracking Tool, and we studied the differences between the two endothelial keratoplasties. Results. Comparing the eyes treated with DMEK with those treated with DSAEK, preoperative corneal thickness, corrected distance visual acuity (CDVA), and age were similar in both groups. SBP was not detectable at preoperative IVCCM in any eye. Postoperatively, the nerve fibers length, the nerve fibers density, the tortuosity, and the number of fibers and of branching did not differ in the eyes that underwent DMEK compared to DSAEK. The corneal beadings density was higher after DMEK than DSAEK, and this difference was statistically significant ( P  = 0.004). The type of endothelial keratoplasty was not associated with the presence or absence of postoperative corneal SBP (Pearson’ chi-square, 0.755). Conclusions. Postoperative corneal reinnervation should be easily and noninvasively studied using IVCCM. Morphological postoperative features of SBP did not differ between two different types of endothelial keratoplasty, DMEK and DSAEK, despite the different sizes of the corneal incision. The lower beading density in the DSAEK group should be the consequence of a different distribution of mitochondria along the nerve fibers, as expression of a supposed higher metabolic distress in the DSAEK group.

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