Journal List > J Korean Ophthalmol Soc > v.49(1) > 1008203

Seo and Kim: Early Result of Femtosecond Laser Assisted Descemet’s Membrane Stripping Endothelial Keratoplasty

Abstract

Purpose

To report the first cases of Descemet’s stripping endothelial keratoplasty in patients with pseudophakic bullous keratopathy.

Methods

Four eyes of 4 patients who had corneal edema from pseudophakic bullous keratopathy were enrolled. We performed femtosecond laser-assisted Descemet’s membrane stripping endothelial keratoplasty (DSEK). We then evaluated preoperative and postoperative best corrected visual acuities (BCVA), manifest refractions, keratometries, topographic astigmatisms, corneal pachymetries, and perioperative complications.

Results

The mean follow-up period was 6 months. Three of the four eyes had successful transplantations. Since the operation, these patients have shown improvement in visual acuity and have recovered from corneal edema. However, in one patient, the transplanted corneal disc was dislocated, and he needed an additional procedure for reattachment.

Conclusions

The lack of corneal incisions or sutures in DSEK was helpful for maintaining corneal curvature and globe integrity after surgery. The surgery resulted in rapid visual rehabilitation and prevented suture-induced complications. With a femtosecond laser, we could prepare donor cornea in an automated and standardized fashion. In conclusion, femtosecond laser-assisted DSEK has significant advantages over standard penetrating keratoplasty for patients with pseudophakic bullous keratopathy.

References

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Figure 1.
Each line represents the changes in best corrected visual acuity for a single patient.
jkos-49-40f1.tif
Figure 2.
Preoperative photo of patient 1 showing corneal edema and haze from pseudophakic bullous keratopathy. Intraocular lens haptic (arrow) is protruded through the previous iridectomy site.
jkos-49-40f2.tif
Figure 3.
Slitlamp photograph of DSEK graft 2 weeks after surgery. Note the clear central cornea with clear interface and smooth surface. The edge of the donor tissue is illuminated (arrow).
jkos-49-40f3.tif
Figure 4.
OCT shows smooth interface and regular thickness of the corneal graft (arrows).
jkos-49-40f4.tif
Figure 5.
Dislocated corneal disc is sutured with 10-0 nylon at 1,3 and 10 o’clock (arrow). Corneal edema is persisted at detached corneal disc (asterisk).
jkos-49-40f5.tif
Table 1.
Preoperative and postoperative clinical details
case Dx* Preop BCVA(logMAR) (logMAR) Postop BCVA Preop specular (cells/mm2) Postop specular (cells/mm2) (µm) Preop pachymetry (µm) Postop pachymetry F/U (month)
1 PBK 2.3 0.3 177 553 684 729 8
2 PBK 1.7 0.4 NA§ 1206 750 756 7
3 PBK 2.3 1.3 NA NA 821 NA 6
4 PBK 2.0 0.7 NA 1503 NA 730 3

* Dx=diagnosis.

BCVA=best corrected visual acuity.

PBK=pseudophakic bullous keratopathy.

§ NA=not available.

Table 2.
Postoperative spherical equivalent and Sim K’s astigmatism
case Dx* Postop Spherical Equivalent (D) Postop Sim K’s Astigmatism (D) F/U (month)
1 PBK -1.25 -2.8 8
2 PBK -0.5 -1.5 7
3 PBK NA NA 6
4 PBK +1.0 -2.8 3

* Dx=diagnosis.

PBK=pseudophakic bullous keratopathy.

NA=not available.

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