scholarly journals Wheel Spokes Technique for Endothelial Keratoplasty for Extremely Mydriatic Bullous Keratopathy Eyes without Capsular Support

2018 ◽  
Vol 9 (1) ◽  
pp. 238-242 ◽  
Author(s):  
Hidenori Tanaka ◽  
Koji Hirano ◽  
Masayuki Horiguchi
Keyword(s):  
Cataract Surgery ◽  
Argon Laser ◽  
Vitreous Cavity ◽  
Bullous Keratopathy ◽  
Sphincter Muscle ◽  
Endothelial Keratoplasty ◽  
Laser Iridotomy ◽  
Acute Glaucoma ◽  
A New Technique ◽  
Capsular Support

We describe a new technique to prevent an endothelial donor graft from dropping into the vitreous cavity during non-Descemet stripping automated endothelial keratoplasty (nDSAEK) for extremely mydriatic bullous keratopathy (BK) eyes without capsular support. The patient was a 79-year-old woman who underwent nDSAEK for an extremely mydriatic BK eye with an incomplete barrier between the anterior and posterior chambers. She had undergone argon laser iridotomy for acute glaucoma at the age of 59 years and cataract surgery 3 years later. The pupil was extremely mydriatic as a result of iris sphincter muscle damage associated with an acute glaucoma attack and cataract surgery. After cataract surgery, the dislocated intraocular lens (IOL) sometimes touched the corneal endothelium. Despite simultaneous surgery to remove the dislocated IOL and lens capsule, vitrectomy, and intrascleral IOL fixation, her corneal endothelial decompensation progressed to BK. During nDSAEK, three 9-0 Prolene suture threads were placed through the recipient’s cornea, limbus-to-limbus, resembling wheel spokes, to prevent the graft from dropping into the vitreous cavity. With the aid of these pre-placed sutures, the graft was inserted safely and was well attached to the host’s posterior cornea by air tamponade without suturing. The wheel spokes technique prevented the endothelial graft from dropping during intraoperative manipulation, suggesting that nDSAEK is possible even in an extremely mydriatic aphakic BK eye without capsule support.

scholarly journals Clinical Evaluation of the NS Endo-Inserter, a Novel Donor Inserter for Descemet’s Stripping Automated Endothelial Keratoplasty

2019 ◽  
Vol 10 (3) ◽  
pp. 357-364
Author(s):  
Akira Kobayashi ◽  
Hideaki Yokogawa ◽  
Natsuko Mori ◽  
Tsubasa Nishino ◽  
Kazuhisa Sugiyama
Keyword(s):  
Anterior Chamber ◽  
Clinical Outcomes ◽  
Intraoperative Complications ◽  
Case Series ◽  
Argon Laser ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Donor Tissue ◽  
Laser Iridotomy ◽  
Cell Densities

Purpose: This study investigated the clinical outcomes achieved with a newly developed donor inserter (NS Endo-Inserter [NSI], HOYA Co., Ltd., Tokyo, Japan) for Descemet’s stripping automated endothelial keratoplasty (DSAEK) in Japanese eyes with bullous keratopathy secondary to argon laser iridotomy (BK-ALI). The NSI device utilizes pressure flow to push the DSAEK donor tissue into the anterior chamber. Methods: Six eyes of 6 patients (1 male, 5 females; mean age, 78.5 years) with BK-ALI were enrolled. Donor tissue was pushed into the anterior chamber using the NSI. Intraoperative complications, graft dislocation, and iatrogenic primary graft failure were recorded for all eyes. Six-month postoperative central donor endothelial cell densities (ECD) were measured prospectively and compared with preoperative values, along with 6-month best corrected visual acuity (BCVA). Results: In all cases, donor loading onto the NSI spatula and donor insertion into the anterior chamber using the NSI was smooth and successful; no intraoperative complications were noted. There were no cases of graft dislocation or IPGF. Postoperative ECD was 2,187.2 cells/mm2 (mean loss, 14.8%) and mean BCVA increased from 0.27 decimal to 0.8 at 6 months. Conclusion: In this small preliminary case series, clinical outcomes for patients with BK-ALI undergoing DSAEK using the NSI were comparable or better than those achieved with conventional DSAEK insertion techniques.

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

2020 ◽  
pp. 112067212097427
Author(s):  
Vijay K Sharma ◽  
Rajesh Sinha ◽  
Alok Sati ◽  
Manisha Agarwal
Keyword(s):  
Case Report ◽  
Cataract Surgery ◽  
Trypan Blue ◽  
Internal Limiting Membrane ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Internal Limiting Membrane Peeling ◽  
Histopathological Correlation ◽  
Pseudophakic Bullous Keratopathy ◽  
Histopathological Evaluation

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.

Argon laser iridotomy-induced bullous keratopathy

2009 ◽  
Vol 93 (6) ◽  
pp. 842-842
Author(s):  
A Narayanaswamy ◽  
R S Kumar ◽  
T Aung ◽  
P J Foster
Keyword(s):  
Argon Laser ◽  
Bullous Keratopathy ◽  
Laser Iridotomy

scholarly journals Iridotrabecular and Iridocorneal Contact Changes after Cataract Surgery and Endothelial Keratoplasty in Bilateral Iridoschisis

2021 ◽  
pp. 198-203
Author(s):  
Takashi Omoto ◽  
Chisato Agata ◽  
Reina Akiyama ◽  
Kohdai Kitamoto ◽  
Tetsuya Toyono ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Surgical Procedures ◽  
Vision Loss ◽  
Anterior Segment ◽  
Corneal Oedema ◽  
Endothelial Keratoplasty ◽  
Laser Iridotomy ◽  
Before And After ◽  
The Right ◽  
Endothelial Decompensation

We report a case of bilateral iridoschisis with corneal oedema and a quantitative evaluation of the changes in iridotrabecular and iridocorneal contact before and after cataract surgery and after Descemet stripping automated endothelial keratoplasty (DSAEK). A 76-year-old woman with iridoschisis and cataracts, previously managed with laser iridotomy, experienced progressive vision loss. The preoperative iridotrabecular contact (ITC) index measured by anterior segment optical coherence tomography was 23.6% in the right eye and 24.4% in the left eye. Preoperative corneal oedema in the right eye was more severe than that in the left eye. Cataract surgery, followed by DSAEK, was performed in the right eye and subsequently in the left eye. Her visual acuity improved postoperatively, and the corneal oedema of both eyes was treated successfully. Moreover, the ITC index improved in both eyes, to 4.7 and 6.9% after cataract surgery and to 0 and 0% after DSAEK in the right and left eyes, respectively. Staged cataract surgery and DSAEK were effective for endothelial decompensation caused by iridoschisis. Additionally, we confirm that iridotrabecular and iridocorneal contacts improved after both surgical procedures not only after cataract surgery but also after DSAEK. This case report showed the clinical usefulness of the ITC index in the detection of changes after different surgical procedures.

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