Improvement Of Corneal Haze After Diagnostic Dwek In A Case Of Presumed Viral Endotheliitis: 1-Year Follow-Up

Published 2022 - 40th Congress of the ESCRS

Reference: PO276 | Type: ESCRS 2022 - Posters | DOI: 10.82333/bpfr-vp46

Authors: Pablo Andres Cisneros Arias* ¹ , Ismael Bakkali El Bakkali ¹ , Eva Nuñez Moscarda ¹ , Miguel Castillo Fernandez ¹ , Marta Suñer ¹ , Constanza Caramello Alvarez ¹ , Javier Ascaso Puyuelo ¹ , Nuria Lopez Rodriguez ¹ , Enrique Minguez Muro ¹ , Isabel Bartolome Sese ¹ , Julia Aramburu Clavería ¹ , Maria Angeles Del Buey Sayas ¹ , Paula Casas Pascual ¹

¹Ophthalmology,Hospital Clinico Universitario Lozano Blesa,Zaragoza,Spain

Purpose

To report a case of persistent corneal oedema after an unknown cause endotheliitis with a severe decrease in endothelial cell contact and clinical improvement after DWEK (descemetorhexis without endothelial keratoplasty).

Setting

Endothelial symptoms are generally secondary to viruses of the Herpes family and less frequently to other viruses. Viral endothelial infections are generally the cause of pseudoguttas. DWEK is reserved for cases of endothelial dystrophy in mild cases with good results after endothelial denudation, causing the peripheral endothelial reserve to migrate towards the area without endothelium and producing improvement of the oedema.

Methods

We present the case of a 61-year-old immunocompetent male patient, with no relevant ophthalmological or systemic history, who after multiple episodes of subacute endotheliitis with retrokeratic precipitates and diffuse iridian atrophy in his right eye, presented a picture of persistent central corneal oedema secondary to a marked decrease in central endothelial cell contact and with a severe decrease in best-corrected visual acuity (0.2) in his right eye even after several months of inflammatory stability. During flare-ups of inflammation, treatment with corticosteroids, topical ganciclovir, and oral acyclovir was prescribed, showing a decrease in inflammatory signs, although with a severe decrease in endothelial cell contact.

Results

Aqueous humor samples were taken during the outbreaks without yielding results for herpesviruses. Endothelial cell contact persisted low several months later, although there was good peripheral cell contact. The fellow eye showed normal. DWEK was performed in the endothelial zone of deposit of retrokeratic precipitates as a diagnostic measure. Endothelial sample for HERPESVIRIDAE FAMILY did not show results, however, a progressive improvement in corneal edema and visual acuity was observed from the first month after DWEK. He is currently stable, with mild paracentral edema and a best-corrected visual acuity of 0.8.

Conclusions

Therapeutic DWEK is reserved for cases of endothelial dystrophy that are not very advanced, in which central endothelial denudation causes centripetal migration of the peripheral endothelial reserve, generating improvement in the guttas and central corneal oedema and, secondarily, in the patient's visual acuity. In this case, the clinical findings suggest a viral etiology of the endothelial loss, therefore, DWEK was considered as a diagnostic procedure, to obtain samples for PCR and as a first step prior to DMEK.

The improvement after descemetorhexis in the area of retrokeratic precipitates without the need for a transplant suggests localized endothelial involvement in cases of endothelial loss associated with localized precipitates.