Descemet Stripping Automated Endothelial Keratoplasty (Dsaek) For Pseudophakic Bullous Keratopathy (Pbk), Serving As A Tectonic Graft Following Neurotrophic Corneal Perforation.

Published 2025 - 43rd Congress of the ESCRS

Reference: PO935 | Type: Poster | DOI: 10.82333/vxar-d574

Authors: Maria-Eleni Papavasileiou ¹ , Chryseida Delimitrou ¹ , Ioannis Pegas ¹ , Konstantinos Rallis* ¹

¹Cornea Department,General Hospital of Athens G.Gennimatas,Athens,Greece

Purpose

To present an interesting case of Pseudophakic Bullous Keratopathy, treated initially with Descemet Stripping Automated Endothelial Keratoplasty, that served as a posterior tectonic patch when a descemetocele was formed because of severe ocular surface disease.

Setting

A 78-year-old man with a history of diabetes mellitus type 2, severe blepharitis and floppy eyelid syndrome presented to the cornea department with pseudophakic bullous keratopathy on the right eye due to Fuchs’ Endothelial Corneal Dystrophy. He had undergone cataract surgery 4 years before. His best uncorrected visual acuity was counting fingers and did not improve with spectacle correction.

Methods

The patient was submitted to Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) and was treated postoperatively with topical broad-spectrum antibiotics and steroids. A week after surgery the graft was fully attached but a large epithelial defect was still present. Autologous serum and intense lubrication was added to the treatment regime and a follow-up examination was scheduled within a week. The patient never attended and four months after surgery he presented with a large epithelial defect (4.1mm), corneal thinning and a descemetocele. Although a multilayered amniotic membrane transplantation was then performed, the ulcer continued to enlarge, thus resulting in a large cornea perforation.

Results

Luckily for the patient the DSAEK tissue acted as a patch, maintaining corneal integrity and providing structural support. During the postoperative follow-up period the graft remained attached but the visual acuity of the patient was hand motion (HM) and the cornea remained thinned. In order to promote visual rehabilitation, a penetrating keratoplasty (PK) was scheduled for the near future.

Conclusions

Ocular surface disease may be a complicating factor in eye graft surgery. In our case, DSAEK was performed in order to improve vision but a large perforation was formed because of the ocular surface disease. In the postoperative period athalamia was prevented, since DSAEK not only restored the normal function of endothelial cells but also worked as a tectonic graft, providing structural support.