Descemet Membrane Endothelial Keratoplasty in Patients with Endothelial Dysfunction after Toxic Ante

Descemet Membrane Endothelial Keratoplasty in Patients with Endothelial Dysfunction after Toxic Anterior Segment Syndrome

2018

Author: Lara R. Newman, MD

Contributors: Michael Straiko, David L. DeMill, Dorian Zeidenweber, Alex Bauer, Khoa Tran, Zachary Mayko, Mark Terry

Purpose:

To report the clinical outcomes of patients who experienced endothelial dysfunction due to toxic anterior segment syndrome (TASS) following cataract surgery and subsequently underwent DMEK (Descemet Membrane Endothelial Keratoplasty).

Methods:

Retrospective chart review of three DMEK cases performed for endothelial dysfunction due to TASS. Outcomes examined include visual acuity, corneal pachymetry, graft detachment, and restoration of corneal clarity.

Results:

All three patients had acceptable visual and anatomic outcomes at last follow-up (six months for two patients, three months for the third). Grafts remained clear and attached, two without further intervention and one after three re-bubbles. Best-corrected visual acuity ranged from 20/20 to 20/25 (LogMAR 0.0-0.1). One patient had significant macular edema, pre- and post-DMEK, secondary to TASS (macular edema was improving and best-corrected visual acuity was 20/25 at last follow-up). Pachymetry improved by 395, 170, and 123 microns.

Conclusions:

DMEK can be successfully used to treat corneal edema from TASS with excellent restoration of corneal clarity. Visual outcomes depend on comorbid ocular conditions, including macular edema. These are the first DMEK cases reported for treatment of endothelial failure due to TASS.