THE PARTIAL DISCEMETOREXIS WITHOUT TRANSPLANTATION IN CASE OF ENDOTHELIAL DYSTROPHY OF CORNEA


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During the last 20 years, the penetrating keratoplasty gave in its leading place to selective lamellar keratoplasty when pathologically altered layers of cornea are selectively replaced, including endothelium. The main technical task of all procedures of endothelial keratoplasty is an obligatory complete or almost complete post-operative adjacency of endothelial transplant to stroma of recipient. However, there are publications concerning resorption of edema in case of separation of endothelial transplant and even at its absence. The purpose of study. To analyze, on the basis of limited clinical observations, the results of partial discemetorexis (5.25 mm) without transplantation in patients with endothelial dystrophy of cornea (Fuchs).The materials and methods. The study was implemented concerning maximal correcting visual acuity, central thickness of cornea, density of endothelial cells and optical density of cornea, before, in one day, in one week, in 1, 3 and every 6 months after operation. The study covered 6 patients with Fuchs dystrophy (average age 63 ± 6,5 years) operated in 2015-2016 with period of observation neither less than 6 months. The visual acuity before operation in average made up to 0,32 ± 017 mkm, average central thickness of cornea - 677 ± 76 mkm. The native crystalline lens was present in 2 patients. The study was supported by ethical committee of the Helmholtz Moscow research institute of eyes diseases. The results. The resorption of edema of cornea occurred in 2 patients (33%), visual acuity increased from 0.45 to 0.6. In different periods density of endothelial cells varied from 549 to 689 kl/mm2. The central thickness of cornea decreased from 613 ± 33 mkm to 553 ± 15 mkm in 12 months after operation. Conclusion. The discemetorexis (5.25 mm) is more often efficient in case of availability of native crystalline lens, at earlier stages of dystrophy independently of patient's age. The discemetorexis ensures lower indices of maximal correcting visual acuity and density of endothelial cells and higher values of central thickness of cornea in comparison with DMEK. The indices of central thickness of cornea and optical density of cornea are exposed to fluctuations in different periods after discemetorexis (5.25 mm).

作者简介

Oganes Oganesyan

The Helmholtz Moscow research institute of eyes diseases of Minzdrav of Russia

Email: oftalmolog@mail.ru
doctor of medical sciences, leading researcher of the department of traumatology and reconstructive surgery the Helmholtz Moscow research institute of eyes diseases of Minzdrav of Russia, 105062, Moscow, Russian Federation 105062, Moscow, Russian Federation

A. Grdikanyan

The Helmholtz Moscow research institute of eyes diseases of Minzdrav of Russia

105062, Moscow, Russian Federation

S. Yakovleva

The Helmholtz Moscow research institute of eyes diseases of Minzdrav of Russia

105062, Moscow, Russian Federation

V. Getadaryan

The Helmholtz Moscow research institute of eyes diseases of Minzdrav of Russia

105062, Moscow, Russian Federation

参考

  1. Balachandran C., Ham L., Verschoor C.A., Ong T.S., van der Wees J., Melles G.R. Spontaneous corneal clearance despite graft detachment in descemet membrane endothelial keratoplasty. Am. J. Ophthalmol. 2009; 148(2): 227-34.
  2. Zafirakis P., Kymionis G.D., Grentzelos M.A., Livir-Rallatos G. Corneal graft detachment without corneal edema after Descemet stripping automated endothelial keratoplasty. Cornea. 2010; 29(4): 456-8.
  3. Ziaei M., Barsam A., Mearza A. Spontaneous Corneal Clearance Despite Graft Removal in Descemet Stripping Endothelial Keratoplasty in Fuchs Endothelial Dystrophy. Cornea. 2013; 32(7): 164-6.
  4. Shah R.D., Randleman J.B., Grossniklaus H.E. Spontaneous corneal clearing after Descemet’s stripping without endothelial replacement. Ophthalmology. 2012; 119(2): 256-60.
  5. Romaniv N., Price M.O., Price F.W., Mamalis N. Donor Descemet membrane detachment after endothelial keratoplasty. Cornea. 2006; 25(8): 943-7.
  6. Srinivasan S., Rootman D. Slit-lamp technique of draining interface fluid following Descemet’s stripping endothelial keratoplasty. Br. J. Ophthalmol. 2007; 91(9): 1202-5.
  7. Suh L.H., Yoo S.H., Deobhakta A., Donaldson K.E., Alfonso E.C., Culbertson W.W. et al. Complications of Descemet’s stripping with automated endothelial keratoplasty: survey of 118 eyes at one institute. Ophthalmology. 2008; 115(9): 1517-24.
  8. Shih C.Y., Ritterband D.C., Rubino S., Palmiero P.M., Jangi A., Liebmann J. et al. Visually significant and nonsignificant complications arising from Descemet stripping automated endothelial keratoplasty. Am. J. Ophthalmol. 2009; 148(6): 837-43.
  9. Bahar I., Kaiserman I., McAllum P., Slomovic A., Rootman D. Comparison of posterior lamellar keratoplasty techniques to penetrating keratoplasty. Ophthalmology. 2008; 115(9): 1525-33.
  10. Ham L., van der Wees J., Melles G.R. Causes of primary donor failure in Descemet membrane endothelial keratoplasty. Am. J. Ophthalmol. 2008; 145(4): 639-44.
  11. Dapena I., Moutsouris M., Ham L., Melles G.R. Graft detachment rate. Ophthalmology. 2010; 117(4): 847.
  12. Ham L., Dapena L., Moutsouris K., Melles G.R. Persistent corneal edema after descemetorhexis without corneal graft implantation in a case of Fuchs endothelial dystrophy. Cornea. 2011; 30(2): 248-9.
  13. Koenig S. Long-term corneal clarity after spontaneous repair of an iatrogenic descemetorhexis in a patient with Fuchs dystrophy. Cornea. 2013; 32(6): 886-8.
  14. Braunstein R.E., Airiani S., Chang M.A., Odrich M.G. Corneal edema resolution after «descemetorhexis». J. Cataract Refract. Surg. 2003; 29(7): 1436-9.
  15. Patel D.V., Phang K.L., Grupcheva C.N., Best S.J., McGhee C.N. Surgical detachment of Descemet’s membrane and endothelium imaged over time by in vivo confocal microscopy. Clin. Exp. Ophthalmol. 2004; 32(5): 539-42.
  16. Choo S.Y., Zahidin A.Z., Then K.Y. Re: Spontaneous corneal clearance despite graft detachment in Descemet endothelial keratoplasty. Am. J. Ophthamol. 2010; 149(3): 531.
  17. Pan J.C., Au Eong K.G. Spontaneous resolution of corneal oedema after inadvertent «descemetorhexis» during cataract surgery. Clin. Exp. Ophthalmol. 2006; 34(9): 896-7.
  18. Watson S., Abiad G., Coroneo M. Spontaneous resolution of corneal oedemafollowing Descemet’s detachment. Clin. Exp. Ophthalmol. 2006, 34(8): 797-9.
  19. Труфанов С.В., Маложен С.А., Пивин Е.А. Восстановление структурной и функциональной целостности эндотелиального слоя роговицы человека после обширного дефекта десцеметовой мембраны (клинический случай). Офтальмология. 2015; 12(1): 96-100
  20. Hoppenreijs V.P., Pels E., Vrensen G.F., Treffers W.F. Corneal endothelium and growth factors. Surv. Ophthalmol. 1996; 41(2): 155-64.
  21. Olsen E.G., Davanger M. The healing of human corneal endothelium. An in vitro study. Acta Ophthalmol. (Copenh). 1984; 62(6): 885-92.
  22. Dirisamer M., Dapena I., Ham L., van Dijk K., Oganesyan O., Frank L.E. et al. Patterns of corneal endothelialization and corneal clearance after Descemet membrane endothelial keratoplasty for Fuchs endothelial dystrophy. Am. J. Ophthalmol. 2011; 152(4): 543-55.
  23. Jacobi C., Zhivov A., Korbmacher J., Falke K., Guthoff R., Schlötzer-Schrehardt U. et al. Evidence of endothelial cell migration after Descemet membrane endothelial keratoplasty. Am. J. Ophthalmol. 2011; 152(4): 537-42.
  24. Stewart R., Hiscott P.S., Kaye S.B. Endothelial migration and new Descemet membrane after endothelial keratoplasty. Am. J. Ophthalmol. 2010; 149(4): 683-4.
  25. Lagali N., Stenevi U., Claesson M., Fagerholm P., Hanson C., Weijdegård B. et al. Donor and recipient endothelial cell population of the transplanted human cornea: a two-dimensional imaging study. Invest. Ophthalmol. Vis. Sci. 2010; 51(4): 1898-904.
  26. Ham L., Dapena I., Moutsouris K., Melles G.R. Persistent corneal edema after descemetorexis without graft implantation. Cornea. 2011; 30(2): 248-9.
  27. Moloney G., Chan U.T., Hamilton A., Zahidin A.M., Grigg J.R., Devasahayam R.N. Descemetorhexis for Fuchs dystrophy. Can. J. Ophthal. 2015; 50(1): 68-72.
  28. Bleyen I., Saelens I.E., van Dooren B.T., van Rij G. Spontaneous corneal clearing after Descemet's stripping. Author reply. Ophthalmology. 2013; 120(1): 215-6.
  29. Koenig S.B. Planned Descemetorhexis Without Endothelial Keratoplasty in Eyes With Fuchs Corneal Endothelial Dystrophy. Cornea. 2015; 34(9): 1149-51.
  30. Arbelaez J.G., Price M.O., Price F.W. Long-term follow-up and complications of stripping descemet membrane without placement of graft in eyes with Fuchs endothelial dystrophy. Cornea. 2014; 33(12): 1295-9.
  31. Borkar D., Veldman P., Colby K. Treatment of Fuchs Endothelial Dystrophy by Descemet Stripping Without Endothelial Keratoplasty. Cornea. 2016; 35(10): 1267-73.

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