Central thickening of the donor posterior corneal disc in femtosecond-laser-assisted Descemet’s stripping endothelial keratoplasty

Abstract

A 49-year-old man complained of progressive visual disturbance oculus dexter (OD), which commenced 1 year earlier. He had undergone cataract extraction OD 20 years earlier and presented with recurrent uveitis over the 5 years before his latest presentation. Best corrected visual acuity (BCVA) OD was 20/100 and intraocular pressure (IOP) was 16 mmHg. Slit-lamp microscopy showed a superiorly distorted iris, aphakia, diffuse corneal edema, and Descemet’s folds. Aphakic bullous keratopathy was diagnosed, and FS-DSEK with secondary intraocular lens (IOL) sulcus fixation was planned. Institutional review board approval and the patient’s written informed consent were obtained. FS laser (60 kHz IntraLase; Abbott Medical Optics, Inc., Santa Ana, CA, USA) was used to prepare a deep horizontal lamellar interface in the donor cornea. The donor corneoscleral rim was placed in a Barron artificial anterior chamber (Katena Products, Inc., Denville, NJ, USA). The pressure in the artificial anterior chamber was assessed by palpation and titrated by controlling irrigation solutions. Intraoperative pachymetry measured the central thickness of the donor cornea as 560 lm. The raster spot pattern was used. Raster energy level of 1.8 lJ was employed to prepare for a horizontal lamellar cut at an intended depth of 390 lm. With the patient under retrobulbar anesthesia, cohesive ophthalmic viscosurgical devices (OVDs) were inserted through the recipient paracentesis site to maintain the anterior chamber. Through a 2.75-mm limbal incision at 9 o’clock of the limbus, a ?11.0 D three-piece IOL (Sensar AR40E, Abbott Medical Optics) was inserted into the anterior chamber and transsclerally sutured with 10-0 Prolene employing the ab externo approach [2]. The target refraction of the inserted IOL was emmetropic. An 8.0-mm-diameter circle of Descemet’s membrane and endothelium was stripped from the recipient cornea using a Price-Sinskey hook (Moria Inc., Doylestown, PA, USA). A 9.0-mm-diameter DPCD was inserted into the anterior chamber through a 5.5-mm limbal incision, and the end of the 10-0 nylon suture was pulled through the paracentesis site. Filtered air bubbles were injected into the recipient anterior chamber and pressed against the DPCD for 10 min. Two months postoperatively, uncorrected visual acuity (UCVA) was 20/400 OD, and the IOP was 17 mmHg OD. J. Y. Kim K.-H. Kim M. J. Kim H. Tchah Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea