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First Author: Z.Marvanova RUSSIA
Co Author(s): M. Bikbov L. Marvanova
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To analyze the results of endothelial transplantation, Descemet"s membrane and posterior layers of the corneal stroma with the usage of automated endothelial keratoplasty technology according to the original method.
Ufa Eye Research Institute, the Academy of Sciences of Republic of Bashkortostan, Ufa, Russia
25 patients observed (25 eyes) with secondary bullous keratopathy (BK) of different etiologies. All patients underwent the automated endothelial keratoplasty - (DSPEK), donor material was obtained by the original method with use of PocketMaker microkeratome. Follow-up period was 2 years. All patients, in addition to the standard ophthalmic examination, received HRT and OCT, the anterior eye segment before and after DSPEK in terms of 1, 3, 6, 9, 12 and 18 months. Before surgery, all patients had corneal syndrome. BK in 10 (42%) patients was complicated by concomitant diseases: glaucoma in 4 (40%), a high degree of myopia in 2 (20%), moderate hyperopia in 1 (10%), AMD in 3 (30%). The mean CCT was 780 ±145 ṁm (normal thickness is 520 ±32,0 ṁm) prior to surgery according to OCT. According to the HRT results subepithelial haze, membranous inclusions, vacuoles in all layers of the cornea, reducing the density of keratocytes in the deeper layers of the stroma, deficiency of endothelial cells. Counting ECD was possible in 19 (79.2%) patients and amounted 840 ±220 cells / mm Ġ. Visual acuity before surgery in 10 (40%) patients was plc - 0.02, in 15 (60%) - 0.03 - 0.08.
A transplant of 7-8 mm in diameter and thickness of 115 ±25,0 ṁm was used during DSPEK. During the surgery no complications were observed. Inflammation reduced in 8-10 days. Endotransplantat diastasis and its dislocation within 1 day occurred in 2 (8%) cases among the complications in the early follow-up period. In one (4%) case the introduction of air into the anterior chamber was required; in the second case the new transplant replacement was required. Within 7-10 days after surgery, 21 (84%) patients had corneal epithelialization. 4 (16%) patients had epitheliopathy up to 3 weeks, haze was in 7 (28%) up to 4 - 6 months. 12 months after surgery thickness of the endokeratotransplantat reached the selected baseline (100,5 ±20,4 m), DEC - 1740 kl. / mm Ġ. Visual acuity was: in 2 patients (8%) 0.05 - 0.09, in 7 (28%) - 0.1 - 0.3, and in 13 (52%) - 0.4 - 0.6, the 3 (12%) - 0.7 - 0.9. After DSPEK for 18 months the transparent corneal engraftment was observed in 23 cases (92%), in 2 cases (8%) - translucent (loss of endothelial cells up to 41%). After 2 years the results of operations remained stable.
Thus an automated endothelial keratoplasty for bullous keratopathy with the usage of transplant obtained by the original technique allows to achieve a significant increase in the anatomical and functional results (92%).