EyeWorld Asia-Pacific December 2019 Issue

EWAP DECEMBER 2019 53 CORNEA by Stefanie Petrou Binder, MD EyeWorld Contributing Writer Contact information Mallias: johnmallias@yahoo.com This article originally appeared in the September 2019 issue of EyeWorld . It JCU DGGP UNKIJVN[ OQFKƂGF CPF CRRGCTU here with permission from the ASCRS Ophthalmic Services Corp. I t’s an unusual case study and one that occurred by mistake. Ioannis Mallias, MD, described the unexpected clinical picture and management of a patient who had a clear cornea after two simultaneous corneal grafts, placed after two separate DSAEK surgeries. The 28-year-old male patient with congenital glaucoma presented at Dr. Mallias’ clinic with two DSAEK grafts and a clear cornea. The patient was monocular, with BCVA 20/400 in his right eye, an ocular prosthesis in his left, and three antiglaucoma valve procedures dating back over many years. After cataract surgery, the patient developed pseudophakic bullous keratopathy with chronic corneal edema. This corneal disease is characterized by corneal stromal edema with epithelial and subepithelial bullae, caused by cell loss and endothelial decompensation through trauma from cataract surgery. It affects 1–2% of cataract surgeries and is caused by heat-related phaco damage and oxidative stress, prolonged phaco, damage vÀœ“ ÌÕÀLՏi˜Ì yœÜ vÀœ“…ˆ}… irrigation/aspiration rates, and is associated with Fuchs’ dystrophy, certain types of glaucoma, and surgeries that can cause trauma and lead to endothelial cell loss, among other etiologies. Corneal transplantation is the gold standard for the treatment of bullous keratopathy, allowing relief of symptoms, such as pain and tearing, and visual acuity recovery. The corneal graft success rate is high, however, there is also a risk of rejection. This patient’s history revealed that he underwent endothelial ŽiÀ>̜«>ÃÌÞ Ì܈Vi° ƂvÌiÀ ̅i wÀÃÌ of these corneal surgeries, the surgeon placed four cardinal Can two DSAEK grafts create a clear cornea? Pentacam (Oculus) images of a patient with two corneal grafts. Slit lamp image showing superimposed corneal grafts. Source (all): Ioannis Mallias, MD