Corneal Refractive Surgery Considerations in Patients on Dupilumab

Abstract

Dupilumab is a biologic approved by the United States Food and Drug Administration (US FDA) for the treatment of atopic dermatitis. While it is an effective medication for eczema, ocular side effects are common in patients receiving dupilumab therapy. Greater consideration is needed when evaluating these individuals for corneal refractive surgery. Dupilumab patients may suffer from atopy, a condition that also merits consideration in those desiring refractive surgery. Additional testing and careful consideration are needed, as these patients have an increased risk of dry eye syndrome, keratoconus, cataracts, diffuse lamellar keratitis, viral keratitis, and perioperative infection. This commentary discusses the current understanding of dupilumab ocular side effects and investigates factors to consider when evaluating these patients for corneal refractive surgery.

Alternativas medicas ante las limitaciones en el trasplante de córnea penetrante: una revisión bibliográfica

“…Otra de las técnicas se conoce como queratoplastia endotelial automatizada con pelado de Descemet (DSAEK) desarrollado por el Dr. Gorovoy, la cual ha tenido mejores resultados visuales que la DSEK original, la cual continúa perfeccionándose, usa además un injerto que consta de endotelio y membrana de Descemet sin ningún estroma. Finalmente, Studeny et al incluyó una técnica menos usada, queratoplastia endotelial de la membrana de Descemet (DMEK) con borde estromal (DMEK-S) con el fin de hibridar con facilidad el manejo dentro del ojo de DSEAK y retener los beneficios visuales de DMEK (Moshirfar et al, 2022).…”

“…Aunque algo controvertido, el hallazgo de una membrana de Descemet robusta en el estroma posterior por neumodisección puede tener implicaciones clínicas y quirúrgicas. (Moshirfar et al, 2022) El endotelio corneal, en conjunto con la función de protección del epitelio y las características únicas de la estructura del estroma, juegan un papel esencial en la preservación de la claridad de la córnea. La monocapa de células endoteliales está formada por células hexagonales que se entrelazan estrechamente y presentan uniones apicales discontinuas.…”

A bilateral corneal descemetocele as a consequence of corneal dystrophy in a ferret (Mustela putorius furo)

“…Corneal dystrophy is a primary, bilateral, symmetrical, noninflammatory condition that has been extensively described in dogs, 1,2 rabbits 3,4 and humans. 5 It consists of loss of transparency due to deposition of abnormal material and is classified according to the location of the deposits. The term corneal dystrophy is also used for Friesian horse's bilateral corneal stromal loss, but this term is used with this meaning only in this specific case.…”

“…Corneal dystrophy is a primary, bilateral, symmetrical, non‐inflammatory condition that has been extensively described in dogs, 1,2 rabbits 3,4 and humans 5 . It consists of loss of transparency due to deposition of abnormal material and is classified according to the location of the deposits.…”

Sutured Descemet Membrane Endothelial Keratoplasty in Patients With Complex Anatomy or Difficulty Positioning

“…F irst described in 2006 by Melles et al, 1 Descemet membrane endothelial keratoplasty (DMEK) is a corneal transplantation technique that replaces only the diseased Descemet membrane and endothelium with donor tissue. In patients with corneal endothelial diseases such as Fuchs dystrophy or pseudophakic bullous keratopathy, DMEK reduces corneal edema and improves visual acuity [2][3][4] at a faster rate and with a lower risk of rejection than penetrating keratoplasty 5 or Descemet stripping automated endothelial keratoplasty (DSAEK). 6 However, one of the biggest challenges of DMEK is the high probability of graft detachment and a need for rebubbling.…”