Descemetorhexis Without Endothelial Graft in Fuchs Dystrophy

Galvis, Virgilio; Tello, Alejandro; Berrospi, Rubén D.; Cuadros, M.O.; Blanco, Nicolás A.

doi:10.1097/ico.0000000000000931

Cited by 13 publications

(10 citation statements)

References 8 publications

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“…4,39,64,93 In 1 case of severe FECD, there was a persistent paracentral edematous area of 3.5-mm diameter, but no DMEK was performed because the patient was satisfied with that outcome. 36 We observed a similar case where a patient was undergoing cataract surgery 2 weeks before DMEK. The surgical view was slightly obscured by the corneal guttae, so an 8-mm descemetorhexis was performed during the cataract surgery.…”

Section: Planned Descemetorhexis Without Graftingmentioning

confidence: 81%

A review of the evidence for in vivo corneal endothelial regeneration

Bogerd

Dhubhghaill

Koppen

et al. 2018

Survey of Ophthalmology

107

104

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Human corneal endothelium has long been thought to be a nonmitotic cell layer with no endogenous reparative potential. Pathologies that damage endothelial function result in corneal decompensation and, if untreated, blindness. The mainstay of treatment involves partial or complete corneal replacement, amounting to 40% of all corneal transplants performed worldwide. We summarize the case reports describing complications postoperatively in the form of (sub)total graft detachment and those resulting in postoperative bare stroma. Complications during cataract and glaucoma surgeries leading to an uncovered posterior cornea are also included. We discuss the newer treatment strategies that are alternatives for current Descemet membrane endothelial keratoplasty and Descemet stripping automated endothelial keratoplasty, including partial grafts and stripping of the diseased cell layer. In more than half of the cases reviewed, corneal transparency returned despite incomplete or no corneal endothelial cell transplantation. We question the existing paradigm concerning corneal endothelial wound healing in vivo. The data support further clinical study to determine the safety of simple descemethorexis in central endothelial pathologies, such as Fuchs endothelial corneal dystrophy, where presence of healthy peripheral cells may allow successful corneal recompensation without the need for donor cells.

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Section: Planned Descemetorhexis Without Graftingmentioning

confidence: 81%

A review of the evidence for in vivo corneal endothelial regeneration

Bogerd

Dhubhghaill

Koppen

et al. 2018

Survey of Ophthalmology

107

104

View full text Add to dashboard Cite

show abstract

“…Multiple early reports also emerged of failed DWEK, either due to nonresolving edema or unacceptable visual outcomes in spite of edema regression. [ 33 34 35 39 ] The largest series of negative outcomes described eight consecutive patients who underwent DWEK with simultaneous phacoemulsification and intraocular lens implantation (“DWEK triple”). After 18 months of follow-up, only one patient maintained corneal clarity and BCVA 20/20, while the remaining seven patients required secondary EK.…”

Section: Deliberate Descemetorhexis Without Grafting – the First Descemetorhexis Without Endothelial Keratoplastymentioning

confidence: 99%

“…[ 39 ] Three other groups collectively described six cases of DWEK or DWEK triple with descemetorhexis sizes of 5–6.5 mm in patients ranging from 40 to 68 years old with suboptimal results at last follow-up (average: 1.5 years, range: 4.5 months–4 years). [ 33 34 35 ] All cases in which surgical technique was described were performed with 360° scoring of central DM. Five of the six patients (83%) had persistent corneal edema and were offered secondary EK.…”

Section: Deliberate Descemetorhexis Without Grafting – the First Descemetorhexis Without Endothelial Keratoplastymentioning

confidence: 99%

Regenerative medicine in Fuchs' endothelial corneal dystrophy

Yuan

Pineda

2021

Taiwan J Ophthalmol

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The management of Fuchs' endothelial corneal dystrophy (FECD) has evolved rapidly since the introduction of endothelial keratoplasty (EK). In recent years, advances in our understanding of endothelial cell biology, in particular with respect to the regenerative capacity of endothelial cells, have opened the door to novel therapeutic options that stray from the traditional paradigm of allograft transplantation. We review the development of descemetorhexis without EK (DWEK) as a primary treatment for FECD and discuss the lessons learned to date about the mechanism of wound healing, surgical technique, patient selection, and refractive outcomes. Multiple randomized clinical trials are currently underway to evaluate the potential for pharmacological supplementation with rho-associated kinase inhibitors to increase the success rate of corneal clearance following DWEK. Biologic supplementation with intracameral endothelial cell injection and acellular Descemet's membrane transplantation are other avenues of adjuvant therapy. DWEK is a promising surgical option for management of a subset of FECD patients.

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“…Some patients achieved corneal clearing while others experienced constant corneal edema and poor visual acuity and final endothelial keratoplasty to improve vision. [ 38 39 40 41 42 43 44 45 ] These inconsistent results may be caused by various corneal thickness, different endothelial cell migration capability associated with age, and the size of descemetorhexis. [ 45 ] This technique may be considered in young patients with mild early central FED, but currently is not recommended as a routine alternative therapy.…”

Section: Introductionmentioning

confidence: 99%

A historical perspective on treatment of fuchs' endothelial dystrophy: We have come a long way

Moshirfar

Ding

Shah

2018

J Ophthalmic Vis Res

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Fuchs' endothelial corneal dystrophy is a hereditary and progressive vision-threatening disease with a high prevalence in our adult population. In the past two decades, endothelial transplantation has dramatically changed the way we treat these patients. Back then, our limited surgical techniques often resulted in less than ideal outcomes. It was unimaginable for our patients to achieve near perfect visual acuity in such a short span of time. Over the years, we have tenaciously refined our surgical techniques to vastly improve patient outcomes, and with the recent advent of Rho-kinase inhibitors, we may even consider delivering a simple injection to our patients in the future. Our purpose is to take a historical perspective on how far we have come in treating this disorder and how rapidly this field will continue to evolve.

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Descemetorhexis Without Endothelial Graft in Fuchs Dystrophy

Cited by 13 publications

References 8 publications

A review of the evidence for in vivo corneal endothelial regeneration

A review of the evidence for in vivo corneal endothelial regeneration

Regenerative medicine in Fuchs' endothelial corneal dystrophy

A historical perspective on treatment of fuchs' endothelial dystrophy: We have come a long way

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