Effectiveness Of Dmek And Dsek In Herpes Related Endothelial Decomepensation

To assess Visual Outcomes following Descemet Stripping Endothelial Keratoplasty (DSEK) and Descemet Membrane Endothelial Keratoplasty in Herpaes related ENdothelial Decomepensation 

2nd Ophthalmology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece

Twenty-seven eyes of 27 patients with endothelial dysfunction caused by herpetic endotheliitis or herpetic keratouveitis were retrospectively analysed. Eighteen patients were female and 9 were male. Patient age ranged from 58 to 87 years. Sixteen patients suffered from herpetic endotheliitis, 9 from herpetic hypertensive keratouveitis. No evidence of Fuchs endothelial dystrophy was noted in the other eye. 15 Patients underwent DSEK and 12 patients underwent DMEK. Postoperatively, patients were administered topical quinolone and dexamethasone QDS and prophylactic per os antiherpetic medication for at least 6 months.

CDVA improved from 0.85±0.22 to 0.37±0.27 logMAR. No event of graft failure was encountered in the 36 months of follow-up. Postoperative CDVA was worse in glaucoma patients, with 3 patients showing minimal improvement from light perception to hand motion (1) and counting fingers (2) respectively. Fundoscopy revealed an almost total optic disc cupping. There was no difference in the postoperative CDVA between ultrathin DSEK (0.32±0.18 logMAR) and PDEK/DMEK (0.24±0.22 logMAR) at 12, 24 and 36 months. All patients reported improved symptoms of pain, photophobia and tearing.

Patients suffering from Herpetic Endotheliatis and Keratouveitis related Endothelial Dysfunction showed a great symptomatic improvement after Endothelial Keratoplasty and significant improvement of VA. Both Descemet Stripping Endothelial Keratoplasty and Descement Membrane Keratoplasty   offer significant improvement in visual acuity in patients with Herpes Related Endothelial Dysfunction Keratopathy with no significant difference between the two groups. Patients with End stage glaucomatous damage benefit from improvement of symptoms but not significant difference in their post-operative visual acuity.