Anterior Lamellar Keratectomy Combined With Descemet Membrane Endothelial Keratoplasty For Significant Corneal Scarring And Chronic Corneal Edema In Eyes With Corneal Endothelial Disease

Published 2022 - 40th Congress of the ESCRS

Reference: PP26.10 | Type: Free paper | DOI: 10.82333/y69t-z549

Authors: Lamis Baydoun* ¹ , Nina Rolf ² , Stefanie Bobe ³ , Birthe Heitkoetter ³ , Peter Barth ³ , Nicole Eter ²

¹Department of Ophthalmology,University Eye Hospital Münster, Münster Germany,Münster,Germany;ELZA Institute,Dietikon / Zürich,Switzerland, ²Department of Ophthalmology,University Eye Hospital Münster, Münster Germany,Münster,Germany, ³Gerhard-Domagk-Institute of Pathology,University Hospital Münster,Münster,Germany

Purpose

To describe the feasibility of anterior lamellar keratectomy combined with Descemet membrane endothelial keratoplasty (DMEK) in eyes with endothelial dysfunction and significant corneal scarring from long-standing corneal edema and to analyse the histologic features of the removed corneal tissue.

Setting

University Eye Hospital Münster, Münster, Germany / Tertiary referral center

Methods

Three eyes of three patients presented in the pandemic period of 2020 with bullous keratopahty (BK) due to uveitis and glaucoma (Case 1), primary DMEK-failure (Case 2) and pseudophakic BK (Case 3). Corneal surgery was postponed by approximately one year for different reasons. All eyes were evaluated with slit-lamp biomicroscopy and anterior segment optical coherence tomography (AS-OCT) and AS-OCT-based-pachymetry before surgery and up to 3 months postoperatively. In Cases 2 and 3, the removed corneal tissue during DMEK was investigated histologically using hematoxylin and eosin staining.

Results

All eyes showed a variable degree of diffuse (Case 1) or central (Cases 2 and 3) corneal scarring and edema. Central pachymetry measured before surgery approximately 820µm, 1100µm and 1800µm in Cases 1, 2 and 3, respectively. On AS-OCT, a hyperdense compact layer between the corneal stroma and the epithelium could be identified. Therefore a subepithelial location of the scar was suspected. In all eyes, removal of this tissue was feasible along the cleavage plane, improving visualisation for DMEK surgery. Histopathologic analyses of the removed specimen confirmed dense fibrotic tissue underneath the epithelium in Case 2 with additional edema in Case 3. Cases 1 and 2 cleared completely, while Case 3 is still clearing after DMEK.

Conclusions

Delaying endothelial keratoplasty in eyes with advanced corneal edema from endothelial dysfunction can result in severe corneal fibrosis and scar that may imply the necessity for a penetrating keratoplasty to restore vision and/or visualisation of deeper ocular structures. Preoperative AS-OCT, however, may reveal a subepithelial rather than stromal location of the fibrosis that can be successfully seperated from the corneal stroma to make also such eyes accessible for the less invasive DMEK procedure.