Descemet's Stripping Without Endothelial Keratoplasty

Daniel Garcerant; Nino Hirnschall; Nicholas Toalster; Meidong Zhu; Li Wen; Gregory Moloney

Disclosures

Curr Opin Ophthalmol. 2019;30(4):275-285. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: To summarize the recent literature regarding descemetorhexis stripping without endothelial keratoplasty (DWEK), increasingly referred to as Descemet's stripping only (DSO). To report the characteristic clinical, confocal and histologic findings associated with this procedure.

Recent findings: Reported clearance rates following DSO range from 63 to 100% in recent series, with variation between surgical techniques. Topical Rho-kinase inhibitor has been reported as successfully salvaging failing cases. Its use as an adjuvant to the surgery is gaining widespread adoption with the results of early series now arriving. Apart from a phenotype of central guttata with clear periphery, patient characteristics which determine success remain elusive. Surgical factors affecting success are increasingly well understood, with stromal injury felt to be a retardant to healing. Characteristic clinical signs have been observed and are described herein. Clinical, confocal and light microscopic images are obtained from patients in clinical trials of DSO with ripasudil.

Summary: DSO is gaining acceptance as a surgical option for a subset of patients with Fuchs' Dystrophy. The addition of Rho-associated kinase inhibitor appears to improve predictability but further results to this effect must be published and scrutinized.

Introduction

The use of healing by primary intention as a planned surgical strategy is well accepted in various sites in the body. This is primarily in the setting of epithelial closure with reliable mitotic ability. Traditional understanding of the human corneal endothelium is that this cellular monolayer is locked in the G1 phase of the cell cycle and unable to replicate in the event of cell loss.[1] This understanding has been challenged for many years,[2,3] with the suggestion being that some mitotic ability is present, more so in youth, more so in the corneal periphery.[2–5] Concurrently, the rapid evolution in endothelial keratoplasty has led to numerous observations of attempted healing in the presence of an endothelial defect,[6–9,10,11] with much basic science suggesting this process can be accelerated pharmacologically.[12–19] The intersection of these findings has led to the exploration of removal of diseased corneal endothelium in Fuchs' dystrophy with planned healing by primary intention as a surgical strategy.

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