Descemetorhexis Without Graft Placement for the Treatment of Fuchs Endothelial Dystrophy: Preliminary Results and Review of the Literature

• Published in: Cornea Vol. 36; no. 6; p. 637
• Main Authors: Iovieno, Alfonso, Neri, Alberto, Soldani, Anna Maria, Adani, Chantal, Fontana, Luigi
• Format: Journal Article
• Language: English
• Published: United States 01.06.2017
• Subjects: Aged; Corneal Topography; Descemet Membrane - surgery; Descemet Stripping Endothelial Keratoplasty; Female; Follow-Up Studies; Fuchs' Endothelial Dystrophy - physiopathology; Fuchs' Endothelial Dystrophy - surgery; Humans; Lens Implantation, Intraocular; Male; Middle Aged; Phacoemulsification; Prospective Studies; Pseudophakia - physiopathology; Visual Acuity - physiology
• ISSN: 1536-4798
• DOI: 10.1097/ico.0000000000001202

To report our preliminary experience with a central descemetorhexis without graft placement in Fuchs endothelial corneal dystrophy (FECD) and to review the existing literature on the topic. A 4-mm central descemetorhexis was performed in 5 patients (4 women, 1 man; mean age: 69.8 ± 8.6 yrs; range: 57-78 yrs) with FECD. All patients had central confluent guttae, undetectable central endothelial cell count, healthy peripheral corneal endothelium, no clinically evident bullous keratopathy, and no ocular comorbidities. In 3 patients, the procedure was combined with phacoemulsification and intraocular lens implantation. All patients completed at least 6 months of postoperative follow-up (mean follow-up 9 ± 2.5 mo; 7-13 mo). Endothelial repopulation of the central stroma was completed in all patients by the third month. Corneal clarity was achieved in 4 of 5 patients. The patient with persistent edema and haze had the highest preoperative central pachymetry. A final improvement in corrected visual acuity was achieved in 4/5 patients. A reduction in preoperative central pachymetry was observed in all cases. All patients developed deep stromal opacities around the margin of the descemetorhexis, which did not resolve over the follow-up time. Abnormal corneal topography and irregular astigmatism developed in 3 of 5 patients; these patients achieved 20/20 corrected distance visual acuity with rigid gas-permeable contact lens fitting. In partial concordance with previous studies, preliminary outcomes of a central descemetorhexis in FECD performed without endothelial graft placement seemed rather unpredictable. Baring of central stroma may trigger a variable wound-healing response with subsequent posterior stromal scarring and topographical irregularity.