DMEK successful in difficult cases that worsened during pandemic
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MILAN — In the midst of the pandemic, three cases of endothelial dysfunction referred for PK due to severe corneal scarring were resolved with anterior lamellar keratectomy and DMEK by Lamis Baydoun, MD, PhD.
“Due to delayed care in the initial stages of the pandemic, severe and progressive subepithelial fibrosis and scarring developed in all three cases,” she said in a poster session at the European Society of Cataract and Refractive Surgeons meeting.
The first case was a 23-year-old man with bullous keratopathy due to panuveitis, an edematous cornea and fibrosis. Best corrected visual acuity was hand motion. The second case was a 48-year-old woman with Fuchs’ dystrophy referred for high-risk penetrating keratoplasty 12 months after failed Descemet’s membrane endothelial keratoplasty, with prominent central corneal scar and corneal vascularization. BCVA was counting fingers. The third case was an 80-year-old man with pseudophakic bullous keratopathy who had postponed DMEK for 2 years due to fear of COVID infection. Fibrosis and vascularization had progressed, and BCVA was hand motion.
“In all three cases, [anterior segment] OCT showed a hyperdense compact layer between the epithelium and the corneal stroma. As confirmed by histology, this was scar tissue but located underneath the epithelium and not within the stroma. Therefore, PKP was unnecessary, and I could successfully peel off the tissue and make the eye accessible for DMEK,” Baydoun said.
AS-OCT examination should always be performed in these patients, she recommended, as it might reveal a subepithelial rather than stromal location of the fibrosis. Lamellar keratectomy would then improve visualization and make the eye eligible for a less invasive DMEK procedure rather than PK.
“Case one achieved 20/30 vision with a contact lens; the cornea is totally clear. Case two improved from 20/100 to 20/40 and has a normal cornea. Case three achieved 20/200, and he is happy because it was still an improvement from HM, and the eye looks good. The vessels regressed without immunosuppressants, just with a normal steroid regimen like every DMEK patient,” Baydoun said.
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Baydoun L, et al. Anterior lamellar keratectomy combined with Descemet membrane endothelial keratoplasty for significant corneal scarring and chronic corneal edema in eyes with corneal endothelial disease. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 16-20, 2022; Milan.
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