Descemetorhexis without endothelial keratoplasty

1 June 2018 | Magdalena Popiela | EYE - Cornea, EYE - General

This retrospective study examined outcomes of the largest reported series of eyes, which underwent Descemetorhexis without endothelial keratoplasty (DWEK) for Fuch’s endothelial dystrophy with mean 10 months of follow-up. Seventeen eyes were included in analysis; with 82.4% achieving corneal clearance on average 3.14 months following surgery, with resultant visual acuity of 20/25 or better in all eyes without other co-morbidities. Comparison between the eyes that failed to clear and eyes that cleared within two to eight months postoperatively demonstrated no statistically significant differences in baseline characteristics: patients’ age, corneal pachymetry, endothelial cell count, guttae density, region of guttae involvement, or presence of preoperative corneal oedema. Three eyes that failed to clear after eight months underwent DWEK with 360 degree Descemet membrane stripping with use of a hook. Whereas in the eyes that achieved a clear cornea, descemetorhexis was performed with forceps in a similar fashion to capsulorhexis. Using a hook results in an irregular margin to Descemet membrane (DM) that allows for small areas of DM detachment, with corresponding pockets of oedema. The authors speculate that the method of descemetorhexis plays an important role in corneal clearance in DWEK, given no differences in patient baseline characteristics. Further studies are needed to establish long-term results and appropriate case selection for DWEK. DWEK performed with descemetorhexis in curvilinear fashion is capable of achieving corneal clearance with good vision in a large percentage of patients.