Long-term Corneal Clarity After Spontaneous Repair of an Iatrogenic Descemetorhexis in a Patient With Fuchs Dystrophy

Abstract

Self-repair of a descemetorhexis and long-term corneal clarity may occur in eyes with underlying endothelial dystrophy.

A review of the evidence for in vivo corneal endothelial regeneration

“…92 Subsequent corneal transplantations could potentially fare worse without the support of nascent endothelial cells; however, cases with persistent edema (Table 3) demonstrate that EK can still be offered as a "rescue procedure" when there is no corneal clearing, ranging from 4 to 8.5 months after stripping. 4,13,14,39,64,116 In our experience, the initial edema resolved without any permanent damage to the stroma (Fig. 8D).…”

“…These cases were all normal corneas apart from 1 case of FECD. 64 Although cataract surgery accounts for most of these accidents, other surgeries have also resulted in an unintentional descemetorhexis. Viscocanalostomy 62 and trabeculectomy 32 have also been associated with unintentional detachment of the Descemet membrane.…”

“…The nonresponsive patients were treated by secondary DMEK with no complications reported or by topical administration with different formulations of rho-associated protein kinase (ROCK) inhibitor, either as Y-27632 or Ripasudil (n ¼ 3). 4,39,64,93 In 1 case of severe FECD, there was a persistent paracentral edematous area of 3.5-mm diameter, but no DMEK was performed because the patient was satisfied with that outcome. 36 We observed a similar case where a patient was undergoing cataract surgery 2 weeks before DMEK.…”

Progressive Corneal Clearance After a DMEK Graft Partially Folded Over on Itself in a Non-Fuchs Pseudophakic Eye

“…However, there are cases, in Fuchs patients, where there has been resolution of corneal edema and endothelial cell repopulation after DMEK procedures with partial or even total graft detachment. [3][4][5][6][7][8][9][10][11] These studies suggest the possibility that the corneal endothelium may be capable of recolonizing the cornea in different ways. In this report, we present a case of non-Fuchs pseudophakic corneal edema with a DMEK graft folded over on itself in which complete reendothelialization and corneal clearance were achieved 7 months after the procedure.…”

Clinical and functional results of one-step phaco surgery and central descemetorhexis for cataract and Fuchs primary endothelial corneal dystrophy

“…Хорошо известен факт, что эндотелиальные клетки роговицы человека не способны к делению и замещение их дефектов идет путем миграции и увеличения площади клеток, что сопровождается уменьшением их плотности на единицу площади [5]. С учетом этого особый интерес представляют публикации, в которых сообщается о восстановлении прозрачности роговицы и повышении зрительных функций у пациентов при спонтанном или даже запланированном удалении ДМ с эндотелием, а также при отсутствии адаптации донорского трансплантата после ТЭДМ по поводу ЭДРФ [6][7][8][9][10]. Это свидетельствует о перспективах изучения данной проблемы в аспекте реабилитации пациентов с патологией эндотелия без применения технологий трансплантации роговицы.…”