Descemet membrane endothelial keratoplasty in a patient with iris-fixated intraocular lens and prior radial keratotomy: a case report

Anvesh Annadanam,Manjool Shah,Timothy Soeken,Nambi Nallasamy

doi:10.1186/s12886-021-02103-1

Anvesh Annadanam, Manjool Shah + Show 2 more

Open Access

https://doi.org/10.1186/s12886-021-02103-1

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Abstract

BackgroundAnterior segment surgeries such as cataract surgery, intraocular lens (IOL) repositioning, and radial keratotomy (RK) may hasten endothelial dysfunction, particularly in the context of pre-existing Fuchs dystrophy, necessitating future corneal transplantation.Case presentationA 68-year-old woman with a history of RK with associated irregular astigmatism in both eyes and iris-fixated intraocular lens (IF-IOL) in the left eye presented with six months of decreased vision in the left eye. She was found to have Fuchs dystrophy and underwent DMEK surgery. She had an uncomplicated postoperative course, with uncorrected visual acuity improving to 20/20 three months after surgery.ConclusionTo our knowledge, this is the first reported case of a highly successful DMEK surgery in a patient with prior RK and IF-IOL.

Highlights

Anterior segment surgeries such as cataract surgery, intraocular lens (IOL) repositioning, and radial keratotomy (RK) may hasten endothelial dysfunction, in the context of pre-existing Fuchs dystrophy, necessitating future corneal transplantation
We present a challenging case of a woman who underwent Descemet membrane endothelial keratoplasty (DMEK) for corneal endothelial decompensation in the setting of Fuchs dystrophy, with a history of both RK and iris-fixated intraocular lens (IF-IOL), as well as prior anterior vitrectomy
With its advantages of minimal invasiveness and excellent postoperative visual outcomes, DMEK surgery has been performed with increasing frequency compared to penetrating keratoplasty (PK) and Descemet stripping automated endothelial keratoplasty (DSAEK) for corneal decompensation for a variety of etiologies [1, 8]

Summary

Introduction

Anterior segment surgeries such as cataract surgery, intraocular lens (IOL) repositioning, and radial keratotomy (RK) may hasten endothelial dysfunction, in the context of pre-existing Fuchs dystrophy, necessitating future corneal transplantation. DMEK can be a challenging procedure to perform on post-vitrectomy eyes and those with potentially unstable intraocular lenses (IOL), such as scleral-fixated IOLs and iris-fixated IOLs (IF-IOLs). Cases of successful DMEK surgery in patients with scleral-fixated and IF-IOLs have recently been reported [7].

Results

Conclusion