Descemet’s Stripping-Automated Endothelial Keratoplasty for Traumatic Aniridia and Aphakia

Sabah S. Jastaneiah

doi:10.1155/2012/982657

Abstract

This Interventional case reports a challenging case of descemet’s stripping-automated endothelial keratoplasty (DSAEK) in a young male patient with traumatic aniridia, aphakia, and corneal edema. Surgery was planned in two stages; first was implantation of aniridia intraocular lens (AIOL), few months later, DSAEK procedure was performed. Successful outcome of both procedures was achieved as measured by the stability of the AIOL, clarity of the cornea, attachment of the lenticule, and improvement in vision. Aniridia implant supports a sufficient amount of air in the anterior chamber especially if the posterior segment is well formed, while providing the required lens power to improve vision. DSAEK procedure challenges that include iris defects and aphakia may be overcome by stepwise planning of the procedure.

Highlights

Descemet stripping automated endothelial keratoplasty (DSAEK) is a procedure used for target replacement of a dysfunctional endothelial cell layer [1]
One hour after the procedure, the patient was checked in the holding area, finding a detached lenticule, he was taken to an operative microscope and air was injected, it was noticed that it was seeping to the posterior segment through the peripheral part of the aniridia implant but the IOP was stable as this was a vitrectomized eye
Patients having aniridia or any iris defects, aphakia, and corneal decompensation were considered a relative contraindication to undergo DSAEK, and they were deprived of the many advantages of endothelial keratoplasty

Summary

Introduction

Descemet stripping automated endothelial keratoplasty (DSAEK) is a procedure used for target replacement of a dysfunctional endothelial cell layer [1]. It has many advantages over conventional penetrating keratoplasty (PKP) in terms of faster visual rehabilitation, induced refractive error (refractive neutral), minimal ocular surface-related changes including sutures and surface-keratopathy-related complications [1, 2]. Indications of the implants are aniridia or iris coloboma to eliminate glare and control the amount of light that enters the eye These lenses can provide additional optical correction and they come in different sizes, shapes, and color (rings or implants). I describe a stepwise approach to manage a case of a young patient having traumatic aniridia, aphakia and corneal edema

Case Presentation

Discussion