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Spontaneous corneal clearance in the presence of a partially detached DSAEK graft after non-DSAEK

Poster Details

First Author: A.Lazaridis GREECE

Co Author(s):    W. Sekundo   S. Souki   C. Koutsandrea   K. Droutsas           

Abstract Details

Purpose:

To report a case of spontaneous corneal clearance after non Descemet Stripping Automated Endothelial Keratoplasty (non-DSAEK) despite graft detachment.

Setting:

Department of Ophthalmology, Philipps University of Marburg, Marburg, Germany

Methods:

A 57 year old man with cataract and bullous keratopathy of the right eye after herpes simplex virus endotheliitis and best spectacle-corrected visual acuity (BSCVA) of 0.1 underwent simultaneous phacoemulsification and non-DSAEK. After two intracameral air injections and 4 months of attachment, the donor disc detached and became fibrotic leading to BSCVA of 0.05. Τhus, the patient was scheduled for re-keratoplasty. At 6 months, prior to re-keratoplasty, biomicroscopy revealed that the recipient cornea in front of the detached donor disc was transparent and without any edema. Therefore, instead of a re-keratoplasty, a mere explantation of the DSAEK graft was performed.

Results:

Four months after graft explantation BSCVA was 0.5 and endothelial cell density (ECD) was 1221 cells/mm². At seven months, BSCVA was 0.6 and ECD was 1181. After 13 months BSCVA was still 0.6 and ECD was 800. Two years later BSCVA was 0.3, ECD was not measurable and corneal thickness and densitometry had increased.

Conclusions:

This is the first report of spontaneous corneal clearance in presence of a partially detached graft after endothelial keratoplasty without descemetorhexis. Prerequisite for endothelial migration in vivo seems to be the loss of contact inhibition. In our case, this condition may indeed apply due to mechanical damage of central host endothelium caused by its sandwiching in the host-donor interface during graft attachment. Moreover, its gradual detachment might had exposed the recipient’s Descemet membrane upon which functional host, donor or host and donor cells have migrated.

Financial Disclosure:

NONE

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