ESCRS - PP14.03 - Management Of Descemetocele In An Eye With Previous Keratoplasties.

Management Of Descemetocele In An Eye With Previous Keratoplasties.

Published 2022 - 40th Congress of the ESCRS

Reference: PP14.03 | Type: Case report | DOI: 10.82333/tcew-ht77

Authors: Pablo Torrelo-Navarro* 1 , Claudia Azpitarte-Sánchez-Muros 1 , Nuria Estébanez-Corrales 1 , Natalia Lorenzana-Blanco 1 , María de las Mercedes Valentín-Pastrana-Aguilar 1 , Javier Alejandro-Palomino 2 , June Artaechevarría-Artieda 1 , Jose Fortes-Alen 2 , Nicolás Alejandre-Alba 1

1Ophthalmology,Fundación Jiménez Díaz University Hospital,Madrid,Spain, 2Pathology,Fundación Jiménez Díaz University Hospital,Madrid,Spain

To report the management and outcome of a descemetocele in a patient with a medical history of rheumatoid arthritis, multiple corneal transplants, corneal infections, and herpetic keratitis in the left eye.

Emergency and Cornea Section, Department of Ophthalmology, Fundación Jiménez Díaz University Hospital, Madrid (Spain).

A 78-year-old male with a history of rheumatoid arthritis (RA), multiple amniotic membrane (AM) implants, keratoplasties (KP), herpetic necrotizing keratitis and corneal infiltrates in left eye (OS), was attended in the Emergency Room because of discomfort and tearing in both eyes for one week. The best corrected visual acuity (BCVA) of the OS was hand movement and biomicroscopy (BMC) exam of the OS revealed a 3-mm, central, non-perforated descemetocele in a decompensated KP graft. With the diagnosis of descemetocele and considering patient’s medical history, urgent surgery was programmed along with topical and systemic treatment. Removal of the KP with descemetocele, replacement with a penetrating KP (PKP), cataract extraction with intraocular lens placement in sulcus and AM implant were carried out. After surgery, treatment with oral and topical corticosteroids and antiherpetic and antibiotic drugs was established. During follow-up, the microbiological and pathological exam didn’t reveal any cause for the descemetocele. The patient started immunosuppressive treatment with mycophenolate mofetil due to RA and developed a persistent corneal epithelial defect which required a second AM implant. After six-month follow-up, OS had a BCVA of 0.3 and a good appearance of the PKP in the BMC exam.

Descemetocele is an infrequent condition in which Descemet’s membrane and corneal endothelium are the only layers forming the cornea. It requires a quick and careful management to avoid corneal perforation of the eye. Treatment depends on the type of descemetocele, however surgery is usually required, as well as an etiological treatment when possible. Descemetocele developed in a KP is even rarer and more difficult to treat. It is important to consider the ophthalmological and the systemic situation of the patient to achieve a successful outcome.