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Rupa D. Shah, J. Bradley Randleman; Spontaneous Corneal Clearance After Descemet Stripping. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6451.
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To present a patient with clinical and histopathologic features of Fuch’s endothelial dystrophy (FED) and Posterior Polymorphous Dystrophy (PPMD) who underwent spontaneous corneal clearance after unilateral Descemet Stripping Endothelial Keratoplasty (DSEK) detachment, and Descemet Stripping (DS) in the contralateral eye with full resolution of corneal edema.
This was a retrospective observation case report of one patient’s clinical course.
A 34 y/o Causasian Female presented to our clinic on May 19, 2009 with a diagnosis of FED in both eyes. BCVA was 20/50 OU. Pachmetry readings were 595 OD, and 597 OS. Slit lamp exam showed multiple pinpoint endothelial abnormalities, resembling guttate. Confocal imaging showed an irregular endothelial pattern. An uncomplicated DSEK was performed OD 7 weeks later. Histopathology specimens were consistent with PPMD, and FED. At POD#1, the graft was found to be inferiorly displaced, and repositioning was performed the same day. On POD#8, primary graft failure was diagnosed, and a repeat uncomplicated DSEK was performed on August 8, 2009. During the consecutive 5 post-op exams from August 17, 2009 to November 11, 2009, increased corneal transparency was noted specifically in areas where the graft was detached. Confocal microscopy showed evidence of new endothelial cells in areas where graft detachment was evident. On November 11, 2009, BCVA OD was 20/80 with complete graft detachment, hence the DSEK graft was removed. By POM#2, the patient’s BCVA OD improved to 20/20. Patient underwent an uncomplicated DS OS on February 15, 2010. At POM#1, BCVA OS was 20/200, and peripheral corneal clearing was noted. Over the course of 4 months, the central cornea began to clear, and vision improved to 20/60. On October 4, 2010, BCVA was 20/25 OU without evidence of corneal edema.
To our knowledge, this is the first case where spontaneous endothelial migration has resulted after descemetorhexis. The underlying pathogenesis of PPMD is likely to have contributed to this fact. Serial confocal images confirm the presence of new endothelial cells appearing to have migrated from the peripheral descemetorhexis site, suggesting that in PPMD, DS alone may be therapeutic. Further studies are encouraged to confirm and elucidate these findings.
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