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Descemet’s stripping only can be right procedure for certain patients

Issue: June 25, 2019

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Deepinder Dhaliwal

SAN DIEGO — Descemet’s stripping only can be a valid option for Fuchs’ dystrophy patients, according to a speaker here; however, patients should meet certain criteria before being recommended for the procedure.

DSO, also called Descemetorhexis without endothelial keratoplasty, or DWEK, removes the central 4-mm zone of Descemet’s membrane and does not include a donor graft.

“Think of it like corneal endothelial rejuvenation,” Deepinder K. Dhaliwal, MD, said at Cornea Subspecialty Day at the American Society of Cataract and Refractive Surgery meeting. “The concept is that guttae are barriers to endothelial cell migration.”

Patients who are good candidates for DSO have central Fuchs’ dystrophy with a clear periphery and an endothelial cell count greater than 1,000 cells/mm². They also should be “patients with patience,” she said.

Vision in the operated eye takes time to recover, so patients need to have good vision in the fellow eye to depend on during that time, Dhaliwal said.

A recent study found that the use of the rho kinase inhibitor ripasudil shortened the lengthy recovery time for DSO, with vision recovering at an average of 4.6 weeks compared to 6.5 weeks, she said.

Patients with advanced corneal stroma edema, peripheral endothelial cell count less than 1,000 cells/mm² or a history of herpes simplex virus or cytomegalovirus keratitis are not good candidates for DSO, according to Dhaliwal.

Performing the procedure should be done carefully.

“It’s a peeling, not a scraping,” Dhaliwal said. “We just want to peel the Descemet’s away because we don’t want to roughen up the stromal fibers.” - by Rebecca L. Forand

Reference: Dhaliwal D. Descemet stripping only: Who is the best candidate? Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 3-7, 2019; San Diego.

Disclosure: Dhaliwal reports no relevant financial disclosures.