Spontaneous Corneal Clearing after Descemet's Stripping without Endothelial Replacement

Abstract

Purpose To report spontaneous corneal clearing with improved visual acuity and central endothelial cell repopulation after Descemet’s stripping without endothelial replacement. Design Interventional case report. Methods A 34 year-old female with bilateral decreased vision secondary to corneal edema from endothelial dysfunction underwent Descemet’s stripping endothelial keratoplasty (DSEK) in the right eye and Descemet’s stripping (DS) only in her contralateral eye. Histopathologic evaluation confirmed a dual diagnosis of Fuchs endothelial dystrophy (Fuchs) and posterior polymorphous membrane dystrophy (PPMD) from Descemet’s membrane specimens removed from each eye. Following primary graft failure with regraft in the right eye, the second posterior corneal lenticule detached, was removed and was not replaced. The cornea cleared and central endothelial cell repopulation was documented by confocal microscopy. Therefore, Descemet’s stripping without endothelial replacement was performed in the left eye. The left cornea also cleared with central endothelial cell repopulation. Main Outcome Measures Postoperative visual acuity and central endothelial cell repopulation Results Endothelial migration after Descemet’s stripping alone in the second eye, with probably host endothelial cell repopulation in the right eye. Conclusions Endothelial cell migration after Descemet’s stripping procedure without insertion of endothelial graft can occur, resulting in host endothelial cell repopulation with corneal clearing and improved visual acuity.

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

“…Confocal microscopy demonstrated complete repopulation of endothelial cells in the central cornea of both eyes. 1 Zafirakis et al 6 described a 60-year-old man with pseudophakic bullous keratopathy in whom the cornea cleared in the early postoperative period, despite recurrent and total detachment of the donor lenticule after DSAEK. Balachandran et al 7 reported 2 cases of Fuchs dystrophy in which spontaneous corneal clearing occurred within 3 months after the Descemet membrane endothelial keratoplasty (DMEK), despite a subtotal detachment of the donor Descemet roll.…”

“…However, a report described spontaneous resolution of corneal edema after a simple descemetorhexis in a patient with endothelial dystrophy. 1 This suggests that the human cornea may be capable of self-repair and maintaining corneal clarity at least for the short term. I herein present a case report of long-term corneal clarity after spontaneous resolution of corneal edema associated with an iatrogenic descemetorhexis in a patient with mild Fuchs dystrophy.…”

Descemetorhexis for Fuchs’ dystrophy

“…To our knowledge, our case represents the third report of intentional Descemetorhexis without any form of transplantation or supplemental therapy as a treatment for Fuchs dystrophy. In 2012, Shah et al 20 reported spontaneous corneal clearing in a 34-year-old after failure to attach an EK lenticule, followed by Descemetorhexis alone in the fellow eye. The area stripped was reported as 8.0 mm in the initial eye and not described in the fellow eye.…”

“…It is probable that the age of the patient bears on the likelihood of success, as many in vitro studies have demonstrated a decreased mitotic ability in older cadaveric corneas. 13 Both Shah et al 20 and Bleyen et al 21 suggested that certain genotypes may be necessary for successful repopulation. Shah et al 20 suggest that on the basis of positive immunohistochemical staining for cytokeratins, their case may represent a variant of posterior polymorphous dystrophy rather than Fuchs, calling into question whether this finding translates to the more common endothelial dystrophy.…”

“…13 Both Shah et al 20 and Bleyen et al 21 suggested that certain genotypes may be necessary for successful repopulation. Shah et al 20 suggest that on the basis of positive immunohistochemical staining for cytokeratins, their case may represent a variant of posterior polymorphous dystrophy rather than Fuchs, calling into question whether this finding translates to the more common endothelial dystrophy. 20,22 We would question this based on the fact that all other data presented in their case including clinical appearance, light microscopy, and confocal microscopy seem consistent with Fuchs dystrophy, and cytokeratin positivity does not preclude the diagnosis of Fuchs, having been previously described in this condition.…”