THE PARTIAL DISCEMETOREXIS WITHOUT TRANSPLANTATION IN CASE OF ENDOTHELIAL DYSTROPHY OF CORNEA

Abstract

During the last 20 years, the penetrating keratoplasty gave in its leading place to selective lamellar keratoplasty when pathologically altered layers of cornea are selectively replaced, including endothelium. The main technical task of all procedures of endothelial keratoplasty is an obligatory complete or almost complete post-operative adjacency of endothelial transplant to stroma of recipient. However, there are publications concerning resorption of edema in case of separation of endothelial transplant and even at its absence. The purpose of study. To analyze, on the basis of limited clinical observations, the results of partial discemetorexis (5.25 mm) without transplantation in patients with endothelial dystrophy of cornea (Fuchs).The materials and methods. The study was implemented concerning maximal correcting visual acuity, central thickness of cornea, density of endothelial cells and optical density of cornea, before, in one day, in one week, in 1, 3 and every 6 months after operation. The study covered 6 patients with Fuchs dystrophy (average age 63 ± 6,5 years) operated in 2015-2016 with period of observation neither less than 6 months. The visual acuity before operation in average made up to 0,32 ± 017 mkm, average central thickness of cornea - 677 ± 76 mkm. The native crystalline lens was present in 2 patients. The study was supported by ethical committee of the Helmholtz Moscow research institute of eyes diseases. The results. The resorption of edema of cornea occurred in 2 patients (33%), visual acuity increased from 0.45 to 0.6. In different periods density of endothelial cells varied from 549 to 689 kl/mm2. The central thickness of cornea decreased from 613 ± 33 mkm to 553 ± 15 mkm in 12 months after operation. Conclusion. The discemetorexis (5.25 mm) is more often efficient in case of availability of native crystalline lens, at earlier stages of dystrophy independently of patient's age. The discemetorexis ensures lower indices of maximal correcting visual acuity and density of endothelial cells and higher values of central thickness of cornea in comparison with DMEK. The indices of central thickness of cornea and optical density of cornea are exposed to fluctuations in different periods after discemetorexis (5.25 mm).