ANTERIOR CH CASE SERIES OF MISDIRECTION SYNDROME IN ENDOTHELIAL KERATOPLASTY: AN UNUSUAL COMPLICATION.

Published 2022 - 26th ESCRS Winter Meeting

Reference: FP101 | Type: Abstracts | DOI: 10.82333/sz1x-jh57

Authors: María García Lorente ¹ , Carlos Rocha-de-Lossada ² , Jorge Peraza-Nieves ³ , Francisco Zamorano-Martin ¹ , Facundo Urbinati* ¹ , Davide Borroni ⁴ , Vito Romano ⁴ , Marina Rodríguez-Calvo-de-Mora ⁵

¹Ophthalmology,Regional University Hospital of Malaga,Málaga,Spain, ²Ophthalmology,University Hospital of Virgen de las NIeves,Granada,Spain, ³Ophthalmology,Clinic Hospital of Barcelona,Barcelona,Spain, ⁴Ophthalmology,University of Liverpool,Liverpool,United Kingdom, ⁵Ophthalmology,Regional University Hospital of Malaga,Málaga,United Kingdom

Purpose

To present a case series of Misdirection Syndrome (MS) that developed during and after Endothelial Keratoplasty (EK).

Setting

Tertiary reference centers

Methods

A retrospective, multicenter study was performed to identify patients who developed MS while undergoing Descemet membrane endothelial keratoplasty (DMEK) and Descemet Stripping with Automated Endothelial Keratoplasty (DSAEK) from 2019 to 2020. Demographic data, preoperative history, operative notes, and postoperative course were reviewed.

Results

We described 10 cases of MS after EK (7 eyes after DMEK and 3 eyes after DSAEK). Mean age was 71.6±12.26 years, 80% were women. Nine patients were pseudophakic; 1 patient had EK combined with phacoemulsification and intraocular lens (IOL) implantation. Average axial length was (AL) 21.61±0.86 mm and the mean intraocular lens power was 27.71±1.60 diopters. Average anterior chamber (AC) volume was 2.16±0.41 mm. All intraoperative cases required pars plana vitreous (PPV) decompression with needle or vitreous cutter. Two postoperative cases of MS were managed only with medical therapy; two required PPV combined with zonulectomy, iridectomy and capsulectomy. Resolution of MS was seen in 8 cases. Average final intraocular pressure was 18.2 ± 3.99 mmHg. Clear graft was achieved in 6 eyes (60%). Six eyes (66.66%) gained one line or more of visual acuity.

Conclusion

We present the largest case series of MS in EK to date. Elderly women, preoperative shallow AC, short AL and previous cataract surgery appear to be common contributing factors.