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Descemetorhexis Without Graft Placement for the Treatment of Fuchs Endothelial Dystrophy: Preliminary Results and Review of the Literature

Iovieno, Alfonso MD, PhD; Neri, Alberto MD; Soldani, Anna Maria OD; Adani, Chantal OD; Fontana, Luigi MD, PhD

doi: 10.1097/ICO.0000000000001202
Clinical Science
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Purpose: To report our preliminary experience with a central descemetorhexis without graft placement in Fuchs endothelial corneal dystrophy (FECD) and to review the existing literature on the topic.

Methods: A 4-mm central descemetorhexis was performed in 5 patients (4 women, 1 man; mean age: 69.8 ± 8.6 yrs; range: 57–78 yrs) with FECD. All patients had central confluent guttae, undetectable central endothelial cell count, healthy peripheral corneal endothelium, no clinically evident bullous keratopathy, and no ocular comorbidities. In 3 patients, the procedure was combined with phacoemulsification and intraocular lens implantation.

Results: All patients completed at least 6 months of postoperative follow-up (mean follow-up 9 ± 2.5 mo; 7–13 mo). Endothelial repopulation of the central stroma was completed in all patients by the third month. Corneal clarity was achieved in 4 of 5 patients. The patient with persistent edema and haze had the highest preoperative central pachymetry. A final improvement in corrected visual acuity was achieved in 4/5 patients. A reduction in preoperative central pachymetry was observed in all cases. All patients developed deep stromal opacities around the margin of the descemetorhexis, which did not resolve over the follow-up time. Abnormal corneal topography and irregular astigmatism developed in 3 of 5 patients; these patients achieved 20/20 corrected distance visual acuity with rigid gas-permeable contact lens fitting.

Conclusions: In partial concordance with previous studies, preliminary outcomes of a central descemetorhexis in FECD performed without endothelial graft placement seemed rather unpredictable. Baring of central stroma may trigger a variable wound-healing response with subsequent posterior stromal scarring and topographical irregularity.

Department of Ophthalmology, Arcispedale Santa Maria Nuova—IRCCS, Reggio Emilia, Italy.

Reprints: Alfonso Iovieno, MD, PhD, Department of Ophthalmology, Arcispedale Santa Maria Nuova—IRCCS, Viale Risorgimento, 80, 42121 Reggio Emilia, Italy (e-mail: alfonsoiovieno@hotmail.com).

The authors have no funding or conflicts of interest to disclose.

Presented at the Fall Educational Symposium—Eye Bank Association of America/Cornea Society Meeting, October 14, 2016, Chicago, IL.

Received November 29, 2016

Received in revised form February 07, 2017

Accepted February 08, 2017

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