Utilization Of Ophthalmic Technology And Advances In Endothelial Keratoplasty: A Case Report

Descemet's membrane detachment (DMD) is a condition characterized by tearing of the Descemet's membrane, which can occur spontaneously or can be iatrogenic during intraocular surgeries. The reported incidence rates of DMD during cataract surgery is approximately 43%.In recent years, advancements in technology have revolutionized the field of ophthalmology, offering new tools and techniques to enhance surgical outcomes and mitigate complications.

In this report, we present a case study of a patient who experienced corneal decompensation and poor vision following cataract surgery a few months prior to presentation. To aid in visualization and decrease surgical stress, we employed anterior segment OCT (AS-OCT),intraoperative OCT, and femtosecond laser-assisted descematorhexis. Additionally, pre- stripped, pre-cut and preloaded endothelial tissue graft for Descemet’s stripping automated endothelial keratoplasty (DSAEK) procedure was used.

A 65-year-old man was referred for poor vision following phacoemulsification in the left eye done four months ago. On presentation, the best corrected visual acuity (BCVA) was 20/400 in the left eye. Slit lamp examination indicated corneal edema with central DMD extended to the inferior two-thirds of the cornea with a fibrotic demarcation line separating the detached Descemet’s from the intact, attached Descemet’s membrane. The anterior segment optical coherence tomography (AS-OCT) confirmed the diagnosis of Type 1 DMD as described by Dua et al., where there is a separation of PDL and DM from the overlying stroma, and the membrane was a relatively thicker, taut, hyperreflective, straight line, like a chord of a circle. The Femtosecond laser-assisted descematorrhexis, intraoperative AS-OCT, and the ready preloaded Descemet stripping endothelial keratoplasty graft were utilized in this case.

This case report highlights the successful management of Descemet's membrane detachment following phacoemulsification surgery using innovative techniques including Femtosecond laser-assisted descematorrhexis and preloaded Descemet stripping endothelial keratoplasty graft. Emphasizing that many technological advancements in the field can be utilized to improve the outcome of endothelial keratoplasty, particularly in cases involving fibrosis associated with combined pre-descemetic layer and Descemet's membrane detachment. These techniques offer promising outcomes for the treatment of this rare complication, leading to significant visual improvement and patient satisfaction.