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Clinical case of suspended spontaneous Descemet's membrane detachment in long-term period after penetrating keratoplasty

Poster Details

First Author: V.Kopayeva RUSSIA

Co Author(s):    O. Kravchuk              

Abstract Details



Purpose:

to describe rare clinical case of suspended spontaneous limited Descemet's membrane (DM) detachment followed 33 years after penetrating keratoplasty (PK) and to analyze new opportunities of anterior segment optical coherent tomography (AS-OCT) in relation with complex corneal pathology.

Setting:

S. N. Fyodorov Eye Microsurgery State Institution, Moscow, Russia.

Methods:

conventional methods (medical story, visual acuity, IOP measurement, visual fields, biomicroscopy) and anterior segment optical coherent tomography (AS-OCT).

Results:

57 years patient referred decades after successful PK on both eyes due to keratoconus (OD - in 1981, OS - in 1985) with non-preserved donor cornea use. Early and long-term post-operational periods were going normal resulting in stable high visual acuity (OU 0.4-0.5 with corr.) and clear grafts. In January 2014 with no preceding trauma patient suffered sharp OD visual acuity decrease, blurred vision, no other complaints. VIS OD=0.01 non corr. VIS OS= 0.4 with corr. OD: eyeball calm, graft thickened, semitranslucent, anterior chamber deep with transparent aqueous humor. The graft edema mostly pronounced in central, upper and external segments. Due to edema of the superficial and medium layers details of DM and endothelium at edematous parts can not be visualized. On OCT advanced pachymetry report uneven corneal thickness increase detected: from 813-874 µm in the centre till 904-1010 in upper and 740-828 in external segments. On OCT scan local limited DM detachment visualized, with distance from the detached membrane till cornea posterior surface 0.75-1.2 mm. OS: eyeball calm, graft of normal thickness, transparent, no other significant changes. On OCT pachymetry corneal thickness varies from 580-600 µm in centre till 584-613 µm on periphery. On OCT scan all corneal layers attached.

Conclusions:

57 years patient referred decades after successful PK on both eyes due to keratoconus (OD - in 1981, OS - in 1985) with non-preserved donor cornea use. Early and long-term post-operational periods were going normal resulting in stable high visual acuity (OU 0.4-0.5 with corr.) and clear grafts. In January 2014 with no preceding trauma patient suffered sharp OD visual acuity decrease, blurred vision, no other complaints. VIS OD=0.01 non corr. VIS OS= 0.4 with corr. OD: eyeball calm, graft thickened, semitranslucent, anterior chamber deep with transparent aqueous humor. The graft edema mostly pronounced in central, upper and external segments. Due to edema of the superficial and medium layers details of DM and endothelium at edematous parts can not be visualized. On OCT advanced pachymetry report uneven corneal thickness increase detected: from 813-874 µm in the centre till 904-1010 in upper and 740-828 in external segments. On OCT scan local limited DM detachment visualized, with distance from the detached membrane till cornea posterior surface 0.75-1.2 mm. OS: eyeball calm, graft of normal thickness, transparent, no other significant changes. On OCT pachymetry corneal thickness varies from 580-600 µm in centre till 584-613 µm on periphery. On OCT scan all corneal layers attached. FINANCIAL INTEREST: NONE

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