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DMEK surgery and ICE syndrome

Poster Details

First Author: M.Vokrojova CZECH REPUBLIC

Co Author(s):    Z. Hlinomazova   L. Filipova   J. Sach              

Abstract Details

Purpose:

The ICE (Iridocorneal Endothelial Syndrome) syndrome is a unilateral, progressive, non-familial, acquired ocular disorder of young adulthood with abnormal corneal endothelium and peripheral anterior synechiae. Secondary glaucoma, iris atrophy, and nodules are associated findings. Etiology of this disorder is still not clear. We present a case report of a young man with progressive blurred vision caused by severe corneal edema. In this case indication of DMEK (Descemet’s Membrane Endothelial Keratoplasty) surgery was done.

Setting:

European Eye Clinic Lexum, Prague, Czech Republic

Methods:

A 35-year old Caucasian man was sent to our department for UMB examination to exclude any malignancy in an anterior segment of his right eye. Preoperatively, we performed standard ophthalmic examination, including UBM, B-scan, and detailed examination of the cornea. During the surgery a tissue sample of the Descemet’s membrane with endothelium and anterior chamber liquid was taken for histopathological investigation and PCR DNA HSV and electron microscopy. Furthermore, we focused on decimal best corrected (BCVA) and uncorrected (UCVA) visual acuity, anterior segment and optic nerve condition in the patient’s right (OD) and left eye (OS).

Results:

Preoperatively, BCVA was 0.05 in OD and 1.0 in OS. Massive corneal edema, epithelial bullae and iris atrophy were observed in OD. UBM did not prove solid processes in iris or iridocorneal angle. Corneal thickness was 800 µm in OD and 580 µm in OS. Left eye showed normal condition. Histopathologic examination including immunohistochemical examination resulted in the diagnosis of ICE syndrome. Anterior chamber liquid proved negative for HSV. Postoperatively, cornea of OD cleared up, edema retreated, lamella was fully attached, UCVA was 1.0. Gonioscopy and anterior segment OCT showed peripheral anterior synechiae. Optic nerve damage was revealed using HRT.

Conclusions:

The diagnosis of iridocorneal endothelial syndrome in our case was determined based on histopathological examination. Our case report also showed that DMEK surgery seems to be a very effective and safe procedure to treat endothelial dysfunction which can be present in ICE syndrome.

Financial Disclosure:

NONE

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