: Fluctuations In Corneal Thickness Associated With Eyelid Padding Following Artificial Corneal Endothelial Implantation: A Case Report

To present an interesting case of fluctuation in corneal thickness following corneal artificial endothelial layer (EndoArt) implantation.

Frimley Park Hospital, UK.

An 80-year-old patient was referred for evaluation of a right corneal graft.Visual acuity was hand movements in the right eye, with significant pseudophakic bullous keratopathy.His ocular history included bilateral trabeculectomies for primary open-angle glaucoma,longstanding right-eye hypotony and compression sutures, followed by blebitis and endophthalmitis that required intravitreal antibiotics.He also had diabetic retinopathy and recurrent vitreous haemorrhages in the left eye.Due to the complexity of his ocular comorbidities and shortage of human donor tissue,the patient was offered two options and implantation of EndoArt as an alternative was chosen.At 1 month follow-up,visual acuity improved to counting fingers,but central corneal thickness (CCT) remained elevated with areas of detachment.The patient underwent rebubbling.At follow up, due to a persistent epithelial defect the patient was managed conservatively, with subsequent temporary tarsorrhaphy.Notably,a month after tarsorrhaphy reversal,CCT significantly decreased to 379μm.Overnight padding for 1 week improved corneal thickness,and this treatment was continued.However,CCT increased to 742 microns, with corneal edema and pockets of graft detachment.Rebubbling was redone,and CCT was reduced to 407 μm at 1 month follow-up.Alternate night eye-padding was advised.Due to variations in CCT and concerns about further thinning the plan involves removal of EndoArt implant with human donor tissue endothelial keratoplasty.

We present a patient with multiple ocular comorbidities who underwent corneal artificial endothelial implantation as an alternative to human donor tissue, amid ongoing tissue shortages. We present the timeline of changes in corneal thickness and the attachment of EndoArt post-operatively, noting fluctuations associated with eyelid padding. It may be helpful to monitor corneal thickness in the mid to long term post operative period.