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Nariya Y, Ono T, Asahina Y, Kondo A, Taketani Y, Kimakura M, Toyono T, Aihara M, Miyai T. A Case of Transparent Cornea Maintained after Removal of Dislocated Graft from Descemet's Stripping Automated Endothelial Keratoplasty. Case Rep Ophthalmol 2024; 15:518-524. [PMID: 39015243 PMCID: PMC11250565 DOI: 10.1159/000539392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/12/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Corneal graft detachment is a major postoperative complication of Descemet's stripping automated endothelial keratoplasty (DSAEK). When a corneal graft becomes detached, corneal endothelial function generally fails, and repeat corneal transplantation is required. Herein, we report a rare case in which a transparent cornea was maintained after the removal of a dislocated DSAEK graft. Case Presentation A 79-year-old woman with a residual lens cortex who had undergone cataract surgery was referred to our hospital. The cortex was removed, and bullous keratopathy progressed. Six months after the initial surgery, DSAEK was performed under topical anesthesia without any complications. Although the corneal graft had attached fairly well, it detached from the host cornea 3 weeks later. Two months after DSAEK, an air tamponade was used to treat the anterior chamber with single interrupted suturing; however, the graft detached again, except for the suture site. Because the detached cornea became cloudy in the anterior chamber, it was surgically removed 8 months after DSAEK. Accordingly, the host cornea transparency improved to a best-corrected visual acuity of 0.8 with a rigid gas permeable lens and a central corneal thickness of 580 μm. The corneal endothelial cell density was 995 cells/mm2. Conclusion Removal of the corneal graft from the dislocated cloudy graft improved the visual acuity of this patient after DSAEK. The condition of the cornea should be carefully monitored after corneal endothelial transplantation, even after the graft has been dislocated.
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Affiliation(s)
- Yuta Nariya
- Department of Ophthalmology, University of Tokyo Hospital, Tokyo, Japan
| | - Takashi Ono
- Department of Ophthalmology, University of Tokyo Hospital, Tokyo, Japan
| | - Yuichi Asahina
- Department of Ophthalmology, University of Tokyo Hospital, Tokyo, Japan
| | - Atsushi Kondo
- Department of Pathology, University of Tokyo Hospital, Tokyo, Japan
| | - Yukako Taketani
- Department of Ophthalmology, University of Tokyo Hospital, Tokyo, Japan
| | - Mikiko Kimakura
- Department of Ophthalmology, University of Tokyo Hospital, Tokyo, Japan
| | - Tetsuya Toyono
- Department of Ophthalmology, University of Tokyo Hospital, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo Hospital, Tokyo, Japan
| | - Takashi Miyai
- Department of Ophthalmology, University of Tokyo Hospital, Tokyo, Japan
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Romano D, Aiello F, Parekh M, Levis HJ, Gadhvi KA, Moramarco A, Viola P, Fontana L, Semeraro F, Romano V. Incidence and management of early postoperative complications in lamellar corneal transplantation. Graefes Arch Clin Exp Ophthalmol 2023; 261:3097-3111. [PMID: 37103622 PMCID: PMC10134734 DOI: 10.1007/s00417-023-06073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/09/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023] Open
Abstract
PURPOSE To provide a comprehensive review of the incidence, risk factors, and management of early complications after deep anterior lamellar keratoplasty (DALK), Descemet stripping automated keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK). METHODS A literature review of complications, that can occur from the time of the transplant up to 1 month after the transplant procedure, was conducted. Case reports and case series were included in the review. RESULTS Complications in the earliest postoperative days following anterior and posterior lamellar keratoplasty have shown to affect graft survival. These complications include, but are not limited to, double anterior chamber, sclerokeratitis endothelial graft detachment, acute glaucoma, fluid misdirection syndrome, donor-transmitted and recurrent infection, and Uretts-Zavalia syndrome. CONCLUSION It is essential for surgeons and clinicians to not only be aware of these complications but also know how to manage them to minimize their impact on long-term transplant survival and visual outcomes.
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Affiliation(s)
- Davide Romano
- Ophthalmology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mohit Parekh
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Kunal A Gadhvi
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Antonio Moramarco
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Pietro Viola
- Department of Ophthalmology, San Bartolo Hospital, Vicenza, Italy
| | - Luigi Fontana
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesco Semeraro
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy
| | - Vito Romano
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy.
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Mandlik K, Nair M. Dislocated Descemet Stripping Endothelial Keratoplasty Lenticule in the Anterior Chamber. JAMA Ophthalmol 2023; 141:e232468. [PMID: 37971509 DOI: 10.1001/jamaophthalmol.2023.2468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
This case report discusses the dislocation of a Descemet stripping endothelial keratoplasty (DSEK) lenticule in a man aged 82 years who underwent DSEK for pseudophakic bullous keratopathy.
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Affiliation(s)
- Kunal Mandlik
- Cornea and Refractive Services, Aravind Eye Hospital, Pondicherry, India
| | - Megha Nair
- Cornea and Refractive Services, Aravind Eye Hospital, Pondicherry, India
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Moura-Coelho N, Cunha JP, Morral M, Gris O, Manero F, Güell JL. Secondary Endothelial Keratoplasty-A Narrative Review of the Outcomes of Secondary Corneal Endothelial Allografts. Transplantation 2021; 105:e347-e365. [PMID: 33675317 DOI: 10.1097/tp.0000000000003735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We review the literature on the efficacy and safety outcomes of secondary Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK). METHODS Literature search of English-written publications up to September 27, 2020 in PubMed database, using the terms "endothelial keratoplasty" in combination with keywords "secondary" or "repeat." In addition, we manually searched the references of the primary articles. RESULTS Twenty-seven studies (n = 651 eyes) were retained and reviewed, including 10 studies on repeat DSEK, 8 studies on repeat DMEK, 6 studies of DMEK following DSEK, and 3 studies of DSEK after failed DMEK. All studies reported significant improvement in visual acuity after secondary endothelial keratoplasty (EK). Twelve studies compared visual outcomes between primary and secondary EK, reporting conflicting findings. Sixteen studies reported endothelial cell loss rates after secondary EK, and only 1 study reported significantly increased endothelial cell loss rates compared with primary EK. Allograft rejection episodes occurred in 1.8% of eyes (range, 0%-50%). Six studies compared complication rates between primary and secondary EK eyes, and only 1 study found a higher median number of complications. However, 2 studies reported higher regraft failure rates compared with primary EK eyes. CONCLUSIONS Secondary EK is surgically feasible and renders significant visual improvement after failed primary EK, although it is not clear whether visual outcomes and allograft survival are comparable with primary EK, raising the question of whether secondary EK eyes are "low risk" as primary EK eyes. Further larger, prospective studies are encouraged to obtain additional quality data on secondary corneal endothelial allotransplantation.
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Affiliation(s)
- Nuno Moura-Coelho
- Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Department of Ophthalmology, Instituto Português de Retina, Lisbon, Portugal
| | - João Paulo Cunha
- Department of Ophthalmology, Hospital CUF Cascais, Cascais, Portugal
- Department of Ophthalmology, Escola Superior de Tecnologia da Saúde de Lisboa do Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Merce Morral
- Cornea and Refractive Surgery Department, Instituto Microcirugía Ocular Barcelona, Barcelona, Spain
- Ophthalmology Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Oscar Gris
- Cornea and Refractive Surgery Department, Instituto Microcirugía Ocular Barcelona, Barcelona, Spain
- Ophthalmology Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Felicidad Manero
- Cornea and Refractive Surgery Department, Instituto Microcirugía Ocular Barcelona, Barcelona, Spain
- Ophthalmology Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - José Luis Güell
- Cornea and Refractive Surgery Department, Instituto Microcirugía Ocular Barcelona, Barcelona, Spain
- Ophthalmology Department, Universidad Autónoma de Barcelona, Barcelona, Spain
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Descemet-stripping automated endothelial keratoplasty with intrascleral haptic-fixated intraocular lens in a sequential vs simultaneous approach. J Cataract Refract Surg 2021; 47:767-772. [PMID: 33196567 DOI: 10.1097/j.jcrs.0000000000000503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK) with intrascleral haptic-fixated intraocular lens (IOL) in a sequential and simultaneous approach. SETTING Tertiary eyecare center. DESIGN Prospective randomized comparative study. METHODS Patients with aphakic or complicated pseudophakic bullous keratopathy visiting a tertiary eyecare center were included in the study. A total of 40 patients were randomized into 2 groups of 20 each. Group 1 had subjects who underwent scleral-fixated IOL (SF IOL) implantation by intrascleral haptic fixation technique, followed by DSAEK (sequential procedure) with an interval of at least 3 months. Group 2 (simultaneous) had subjects who underwent DSAEK with SF IOL as a combined procedure. Graft survival, endothelial cell loss (ECL), corrected distance visual acuity (CDVA), and need for any intervention such as rebubbling were evaluated for both the groups at the end of 6 months. RESULTS At 6 months, the sequential group had significantly better CDVA of 0.62 ± 0.17 logMAR compared with 0.87 ± 0.19 logMAR in the simultaneous group (P = .002). Group 1 had significantly better overall cumulative graft survival (100% vs 60%, P = .002), significantly lower ECL (P = .006), lesser mean central corneal thickness (P = .03), and significantly thinner donor lenticule (P = .009). Rebubbling rate was significantly higher in Group 2 (P = .025). The mean hyperopic shift was significantly more in Group 2 (P = .02). CONCLUSION The sequential procedure of SF IOL followed by DSAEK has better visual outcomes and graft survival when compared with simultaneous procedure in cases of aphakic or complicated pseudophakic bullous keratopathy.
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Deshmukh R, Nair S, Ting DSJ, Agarwal T, Beltz J, Vajpayee RB. Graft detachments in endothelial keratoplasty. Br J Ophthalmol 2021; 106:1-13. [PMID: 33397659 DOI: 10.1136/bjophthalmol-2020-318092] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/14/2020] [Accepted: 12/19/2020] [Indexed: 12/23/2022]
Abstract
Graft detachment is the most common complication of endothelial keratoplasty. With the ongoing advancements in the field of endothelial keratoplasty, our understanding of risk factors of graft detachments and its management has been evolving. Various prevention measures have been described in literature including presoaking the donor graft, anterior chamber tamponade, venting incisions, sutures to prevent dislocation of graft. Management of a detached graft involves secondary interventions such as rebubbling, suturing and regrafts. In this review, we discuss graft detachment in different types of endothelial keratoplasty techniques including Descemet stripping endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty; with emphasis on incidence, risk factors, preventive measures and their management.
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Affiliation(s)
- Rashmi Deshmukh
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sridevi Nair
- Department of Ophthalmology, All India Institute of Medical Sciences Dr RP Centre for Ophthalmic Sciences, New Delhi, India
| | - Darren Shu Jeng Ting
- Academic Ophthalmology, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Tushar Agarwal
- Department of Ophthalmology, All India Institute of Medical Sciences Dr RP Centre for Ophthalmic Sciences, New Delhi, India
| | - Jacqueline Beltz
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Rasik B Vajpayee
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia .,Centre for Eye Research Australia, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Ophthalmology, Vision Eye Institute Ltd, Melbourne, Victoria, Australia
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Rocha-de-Lossada C, Marín-Martínez S, Torras-Sanvicens J. Subconjunctival bulbar and superior fornix migration of SF6 through the valvular drainage device after rebbubling due to DSAEK graft detachment. ACTA ACUST UNITED AC 2020; 95:e51. [PMID: 32471742 DOI: 10.1016/j.oftal.2020.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 11/24/2022]
Affiliation(s)
- C Rocha-de-Lossada
- Institut Clinic d'Oftalmologia, Hospital Clinic de Barcelona, Barcelona, España.
| | - S Marín-Martínez
- Institut Clinic d'Oftalmologia, Hospital Clinic de Barcelona, Barcelona, España
| | - J Torras-Sanvicens
- Institut Clinic d'Oftalmologia, Hospital Clinic de Barcelona, Barcelona, España
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