Corneal Pigment Opacity From Face-Down Positioning After Pars Plana Vitrectomy, Treated With Descemet Stripping Only Technique

Abstract

The purpose of this study was to report a case of corneal opacity resulting from pigment deposition after face-down positioning, which was treated with Descemet stripping only (DSO) to enable concurrent pars plana vitrectomy (PPV) for retinal detachment repair. Methods:A 79-year-old man with a history of Fuchs endothelial dystrophy and retinal detachment presented for the repair of recurrent retinal detachment and evaluation of a central corneal opacity. Results:The patient was found to have significant corneal endothelial pigment deposition obscuring the view to the fundus. A repeat macula-involving retinal detachment was visualized on limited fundoscopic examination and confirmed using ultrasonography. The patient subsequently underwent combination scleral buckle, DSO, and PPV. DSO achieved corneal clarity for the entire duration of the PPV and allowed for the necessary postoperative face-down positioning. Immunohistochemistry of the corneal specimen revealed deposition of retinal pigment epithelium as the origin of the pigment opacity. The corneal edema cleared at postoperative month 4, and the retina remained attached, resulting in an improvement of visual acuity from counting fingers preoperatively to 20/70.Discussion: This is, to the best of our knowledge, the first case describing the formation of a corneal endothelial opacity because of retinal pigment epithelium deposition associated with face-down positioning after PPV for retinal detachment. DSO is a minimally invasive, viable alternative to endothelial keratoplasty or temporary keratoprosthesis placement for the clearance of focal corneal endothelial opacities for PPV.

Role of descemet's stripping without keratoplasty in management of endothelial disease

“…In another adaptation of the technique, Yung et al [29] reported use of DSO to achieve corneal clearance of pigment deposition which had developed after pneumatic retinopexy. In this case a pseudophakic patient with FECD was found to have corneal opacity due to endothelial pigment deposition following a previous pneumatic retinopexy and face down positioning [29]. DSO was performed, facilitating posterior segment visualization to complete a pars plana vitrectomy and scleral buckle treating recurrent retinal detachment.…”

“…DSO was performed, facilitating posterior segment visualization to complete a pars plana vitrectomy and scleral buckle treating recurrent retinal detachment. At 6-month postoperative review corneal clearance was maintained within the descemetorhexis [29].…”