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Daniel Greene, Ryan K Wong, Charles Eberhart, John J Huang, Aryan Shayegani; DSAEK Descemetorhexis in Two Patients with Anterior Segment Fibrosis after Multiple Intraocular Surgeries. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2023.
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To report clinical and histopathologic findings of the posterior cornea in two patients with a history of multiple intraocular procedures and to describe a surgical approach for descemetorhexis in these cases.
Interventional case series.
Two patients developed unilateral bullous keratopathy following pars plana vitrectomies, cataract surgeries, and glaucoma filtering surgeries with multiple anterior chamber drainage devices. Both underwent Descemet’s stripping automated endothelial keratoplasty that was complicated by difficult descemetorhexis due to fibrotic posterior corneal tissue seen intraoperatively that was consistent with stromal downgrowth on histopathologic analysis. In these cases, descemetorhexis necessitated unconventional instruments including a reverse cystotome and intraocular scissors. Both patients developed detachments of the endothelial grafts and subsequent re-bubbling procedures.
Patients with bullous keratopathy secondary to multiple surgeries and anterior segment surgical implants may pose intraoperative challenges due to thickened and scarred posterior corneal tissue. It is imperative for surgeons performing endothelial keratoplasty on such patients to consider unique approaches to descemetorhexis as described herein or alternative techniques such as endothelial keratoplasty without Descemet stripping, penetrating keratoplasty, and deep lamellar endothelial keratoplasty.
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