Endoart Implant For The Treatment Of Corneal Edema In A Complex Eye

To present the management of a patient with a complex ocular history and corneal edema secondary to Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) using the EndoArt implant. This case highlights the rationale for selecting the EndoArt implant, the challenges encountered and the surgical and postoperative outcomes, emphasizing strategies for optimizing visual rehabilitation in complex cases.

Ophthalmology Department, Hillel Yaffe Medical Center, Hadera, affiliated with the Technion Institute of Technology, Haifa, Israel.

A 30-year-old male with congenital cataract and advanced glaucoma was referred following recent DSAEK failure, Visual acuity of light perception (LP) and elevated intraocular pressure (IOP) in his only eye. His left eye was phthisical.

His right eye had undergone cataract extraction with anterior chamber intraocular lens (AC IOL) implantation, trabeculectomy and DSAEK with multiple unsuccessful rebubblings and graft failure two months before referral. After stabilizing his IOP with a Xen implant and cyclophotocoagulation, our focus shifted to visual rehabilitation.

Repeat DSAEK posed a high risk of failure and rejection due to the previous failed graft and AC IOL. Prolonged topical steroid use could further compromise IOP control and multiple prior surgeries increased the risk of phthisis. Given these risks, the EndoArt silicone implant was chosen. This 50μ, 6.5mm implant creates a passive fluid barrier while allowing peripheral nutrition exchange, eliminating graft rejection and reducing steroid dependence.

Intraoperatively, the failed DSAEK was removed, and the EndoArt implant was inserted using the pull-through technique, floated with Octafluoropropane (C3F8) gas and secured with 10-0 nylon sutures. Postoperatively, corneal transparency and visual acuity improved, restoring independence and quality of life. BCVA improved from LP to 0.9 LogMAR, with IOP maintained within normal limits. Slit-lamp and OCT images illustrate surgical and postoperative challenges.

The EndoArt implant is safe and effective treatment for visual rehabilitation in patients with complex ocular history and corneal edema where other alternatives may carry poor outcome; eliminating the risks of graft rejection and failure while reducing dependence on long-term topical or systemic steroid therapy.