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

Outcomes of Subsequent Transplants and Cataract Extraction

A valid concern amongst corneal specialists regarding this procedure is the impact on any subsequent corneal graft that may be required. Early reports are reassuring. In 2017 Rao et al.[51] reported outcomes of DMEK in three patients after failed DSO surgery. In the short term, two of three patients achieved 20/20 vision with high cell counts. One patient achieved 20/70 vision with postoperative anterior chamber inflammation and cystoid macular edema that responded to topical therapy. In our own center, since 2014, three grafts have been performed for nonresponding DSO patients. One patient received a DSEK after failing rescue therapy with Rho-kinase inhibitor – compounded Y-27632.[44] A DSEK was chosen because of the presence of Descemet's fibrosis and local detachment. Vision remains 20/25 at 3 years. Two patients failed to respond to the procedure despite the use of topical ROCK inhibitor from day 1 postoperatively. Both received a DMEK with vision of 20/20 and 20/25 restored (Figure 9). More detailed analysis and reporting of these outcomes will follow and are important to reassure our patients that the choice of a DSO does not compromise any future endothelial keratoplasty. Combining this procedure or staging this procedure with cataract surgery does not seem to affect outcomes thus far.[20,36,46]

Figure 9.

(a) Slit lamp photograph 12 weeks post Descemet's stripping only with no formation of clear zone, with decision made to proceed to Descemet's membrane endothelial keratoplasty (DMEK). (b) Slit lamp photograph of same patient 8 weeks post DMEK demonstrating clear cornea and restoration of vision to 20/25.

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