Case Report - Ophthalmology Case Reports (2023) Volume 7, Issue 4
Endothelial keratoplasty for bullous keratopathy in microcornea with anterior chamber intraocular lens: A clinical report with surgical challenge.
To explain how to treat eyes with an Anterior Chamber Intraocular Lens (AC IOL) and phakic or pseudophakic bullous keratopathy using thin Descemet-Stripping Endothelial Keratoplasty (thinDSEK) or Descemet Membrane Endothelial Keratoplasty (DMEK), with or without removing the AC IOL. Secondary referral facility contrasting case studies. Descemet membrane endothelial keratoplasty, also known as thin-DSEK, was carried out in pseudophakic eyes fitted with iris-claw AC IOLs (group 1) or in phakic eyes fitted with angle-supported AC IOLs (group 2) in pseudophakic eyes. Except in eyes with insufficient corneal transparency or a significant risk for graft separation, DMEK was frequently carried out in both groups. The endothelial cell density, postoperative Corrected Distance Visual Acuity (CDVA), preoperative surgical considerations, and complications were also recorded. All of the AC IOLs in group 1 were left in place. 90% of patients in group 2 involved the removal of AC IOLs. At six months, 36% of eyes in group 1 and 90% of eyes in group 2 had CDVAs of 20/40 (0.5 decimal) or better. 20% of eyes experienced graft detachment and 29% experienced de novo or worsening of glaucoma. DMEK made it possible to treat bullous keratopathy in eyes fitted with an AC IOL. If postoperative difficulties are predicted, removal of the intraocular lens may be necessary, but not for surgical purposes. With DMEK in eyes with a phakic AC IOL and normal visual potential and thin-DSEK in eyes with low visual potential and/or concurrent disease, the surgical strategy may overall aim to minimise postoperative problems. Dutch ophthalmic USA and DORC international BV both employ Dr. Melles as a consultant.Author(s): Ankita Singh