Tectonic DSAEK for the Management of Impending Corneal Perforation

Abstract

Purpose. To report a case of severe corneal thinning secondary to dry eye treated with a tectonic Descemet stripping automated lamellar keratoplasty (DSAEK) and amniotic membrane graft. Methods. A 72-year-old man with a history of long standing diabetes mellitus type 2 and dry eye presented with 80% corneal thinning and edema on the right eye and no signs of infectious disease, initially managed with topical unpreserved lubrication and 20% autologous serum drops. Eight weeks after, the defect advanced in size and depth until Descemetocele was formed. Thereafter, he underwent DSAEK for tectonic purposes. One month after the procedure, the posterior lamellar graft was well adhered but a 4 mm epithelial defect was still present. A multilayered amniotic membrane graft was then performed. Results. Ocular surface healed quickly and reepithelization occurred over a 2-week period. Eight months after, the ocular surface remained stable and structurally adequate. Conclusion. Tectonic DSAEK in conjunction with multilayered amniotic graft may not only provide structural support and avoid corneal perforation, but may also promote reepithelization and ocular surface healing and decrease concomitant inflammation.

Clinical application and evaluation of hyperdried human amniotic membrane for the surgical repair of oral mucosal defects

“…The AM is thin and tough but devoid of blood vessels, lymphatics, and nerves. AM can also produce a wide array of growth factors, provide a healthy new substrate suitable for re‐epithelialization, and promote epithelial healing . For many years, fAM or cryopreserved AM (cAM) has been used as free grafts and applied in various areas .…”

“…AM can also produce a wide array of growth factors, provide a healthy new substrate suitable for re‐epithelialization, and promote epithelial healing . For many years, fAM or cryopreserved AM (cAM) has been used as free grafts and applied in various areas . These membranes also have been used as a biodegradable graft material for mandibular vestibuloplasty, but there have been some persistent problems.…”

Hyperdry human amniotic membrane is useful material for tissue engineering: Physical, morphological properties, and safety as the new biological material

“…AM has been shown to have anti‐inflammatory and antimicrobial effects along with antifibroblastic activity and antiangiogenic properties, and has been reported to reduce scarring . AM can also produce a wide array of growth factors, provide a healthy new substrate suitable for reepithelization, and promote epithelial healing …”

“…2 AM can also produce a wide array of growth factors, 18 provide a healthy new substrate suitable for reepithelization, and promote epithelial healing. 19 Clearly, AM has many characteristics that make it potentially attractive as a biomaterial; it is cheap and easily obtained, and its availability is virtually limitless, negating the need for mass tissue banking. However, despite many uses of AM, little is known about the underlying mechanisms of action and the extent of these effects.…”

Transplante endotelial: em busca de qualidade visual

“…Há relato também do uso de enxertos endoteliais em casos de iminência de perfurações corneanas, promovendo suporte tectônico até completa recuperação da área de fragilidade (descemetocele). 34 Dirisamer descreveu alguns casos em que houve descolamento do enxerto endotelial, porém a córnea recuperou a transparência.…”