Abstract
BackgroundEpithelial downgrowth is a rare complication after Descemet stripping automated endothelial keratoplasty (DSAEK), which usually leads to poor visual outcome despite multiple available options of treatment.Case presentationA 50-year-old man underwent DSAEK procedure due to pseudophakic bullous keratopathy. Three months later, the patient presented with gradual visual loss; slit-lamp examination revealed detachment and folding of the DSAEK lenticule, which was confirmed by anterior segment optical coherence tomography. On confocal scanning, epithelial cell sheets were detected in the interface leading to the wrinkling of the donor tissue and donor detachment. Surgical debridement and transient fixating with straight 10–0 prolene needles were performed followed by air injection into the anterior chamber. The cornea turned clear in the one-year follow-up with uncorrected-visual acuity of 20/30 and best-corrected visual acuity of 20/25.ConclusionsEarly diagnosis and treatment of epithelial downgrowth may be associated with a good prognosis and prevent from more aggressive treatments such as repeat of grafting. In this case, mechanical debridement and transient fixation of lenticule by 10–0 prolene needles was performed to manage post-DSAEK epithelial downgrowth and lenticule detachment, which was successful without requiring of additional re-grafting. It seems this is a feasible technique with acceptable long-term outcomes.
Highlights
Epithelial downgrowth is a rare complication after Descemet stripping automated endothelial keratoplasty (DSAEK), which usually leads to poor visual outcome despite multiple available options of treatment.Case presentation: A 50-year-old man underwent DSAEK procedure due to pseudophakic bullous keratopathy
Early diagnosis and treatment of epithelial downgrowth may be associated with a good prognosis and prevent from more aggressive treatments such as repeat of grafting
Mechanical debridement and transient fixation of lenticule by 10–0 prolene needles was performed to manage post-DSAEK epithelial downgrowth and lenticule detachment, which was successful without requiring of additional re-grafting
Summary
Case presentation: A 50-year-old man underwent DSAEK procedure due to pseudophakic bullous keratopathy. Soleimani et al BMC Ophthalmology (2022) 22:41 detachment and epithelial downgrowth after Descemet Stripping Automated Endothelial Keratoplasty, which managed through surgical debridement and transient fixating of lenticule by straight 10–0 prolene needles not requiring a re-grafting. Case presentation A 50-year-old man presented with pseudophakic bullous keratopathy after cataract surgery His visual acuity was counting fingers at 1 m; the posterior capsule was intact with well-positioned intraocular lens (IOL) in the bag. The patient presented with gradual visual loss three months later and the DSAEK lenticule was detached, non-mobile and folded confirmed by anterior segment optical coherence tomography (ASOCT) (CASIA SS-1000, TOMEY, Nagoya, Japan) (Fig. 1a, b). On confocal scanning microscopy (Heidelberg Retina Tomograph 3 with the Rostock Cornea Module, Heidelberg Engineering GmbH, Dossenheim, Germany), epithelial cell sheets were detected in the interface leading to the wrinkling of the donor tissue and detachment (Fig. 1c)
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