ENDOTHELIAL KERATOPLASTY IN PATIENT AFTER TASS SYNDROME
Published 2022 - 26th ESCRS Winter Meeting
Reference: CR38 | Type: Cornea Day Case Presentations | DOI: 10.82333/pq64-ke51
Authors: Anastasia Khaletskaya 1 , Boris Malyugin* 2
1ophthalmology,S. Fyodorov Eye Microsurgery Federal State Institution,Moscow,Russian Federation, 2ophthalmology,S. Fyodorov Eye Microsurgery Federal State Institution,Moscow,Russian Federation;ophthalmology,A.I. Yevdokimov Moscow State University of Medicine and Dentistry,Moscow,Russian Federation
To present the technique and unusual intraoperative findings in patient having DSAEK for pseudophakic bullous keratopathy associated with ASS syndrome.
A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
A 66-year-old man was referred to our clinic with complaints on low vision, tearing, photophobia of the left eye (LE). Several years earlier patient had undergone antiglaucoma surgeries elsewhere. IOP was stable. Phacoemulsification (PE) with posterior chamber multifocal IOL implantation was performed on the LE in the other clinic couple of months prior to consultation. On the next day after PE no visual recovery was achieved and the patient was diagnosed with TASS-syndrome. Management was including intensive instillations and injections of steroids.
At the time of examination: LE - flat filtering bleb positioned at 12 o'clock, diffuse limbus-to-limbus corneal edema with Descemet's membrane folds. The anterior chamber was deep with peripheral irido-corneal adhesions, areas of local iris atrophy were noted. Ex-press shunt was visualized at the 2 o'clock position. IOL was in the capsular bag. Fundus examination was not possible. BCVA of LE - 0.1 (decimal), IOP - 15 mmHg. Diagnosis: LE Pseudophakic bullous keratopathy. Primary open-angle glaucoma II A. The decision was made to perform endothelial keratoplasty (DSAEK). During surgery transparent retro-corneal membrane fully covering the iris and extending to the anterior chamber angle was identified. Tube portion of the Ex-press shunt was embedded in the membrane and partially blocked with the iris. Membrane removal with anterior chamber angle cleaning were performed followed by descemetorhexis, insertion of endothelial graft and suturing the surgical wounds. Postoperative period was unremarkable with VA increased up to 0.6 (decimal) 3 mo. after surgery with IOP - 14 mmHg.
TASS syndrome is one of the very serious and deleterious cataract surgery complications. Performing endothelial keratoplasty 3 months after the onset of that condition allowed for relatively quick visual rehabilitation.