The use of endoillumination probe-assisted Descemet membrane endothelial keratoplasty for bullous keratopathy secondary to argon laser iridotomy

Abstract

PurposeTo report the first case of Descemet membrane endothelial keratoplasty (DMEK) for bullous keratopathy (BK) secondary to argon laser iridotomy (ALI).PatientA 71-year-old woman presented with decreased visual acuity in her right eye due to BK secondary to ALI that was performed 10 years prior.ResultsPhacosurgery was performed first, followed by successful DMEK 4 months later. A DMEK shooter was used for donor insertion, which allowed for a stable anterior chamber during donor insertion, even when the anterior chamber was quite shallow. Also, removal of edematous epithelial cells and endoillumination probe-assisted DMEK was quite useful to visualize DMEK graft on the background of the dark brown iris seen in Asian eyes. The patient’s best corrected visual acuity rapidly increased from 20/200 to 25/20 after 1 month, with complete resolution of corneal edema.ConclusionWe reported the first successful DMEK case for BK secondary to ALI. The use of a DMEK shooter for donor insertion and endoillumination assistance to visualize the DMEK graft was a useful technique for BK secondary to ALI.

<p>Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization</p>

“…Various modifications have been proposed to overcome the difficulty of poor visualization during DMEK procedure. These modifications include chandelier illumination by Shimizu et al, transcorneal illumination by Jacob et al and Kobayashi et al 12,20,21 Use of chandelier illumination has several limitations such as need for a dilated pupil that could cause problems in graft unfolding, increased risk of endothelial damage. 21 Endoilluminator-assisted DMEK allows easy identification of graft orientation as well as easy visualization of the graft during all steps of surgery.…”

Case series and techniques of Descemet’s Stripping Automated Endothelial Keratoplasty for severe bullous keratopathy after birth injury

“…However, it should be noted that the combination of these techniques is quite useful not only for enhancement of visualization of cataract surgery, but also for irregular Descemet’s membrane removal through bullous stromal changes. In addition, the combination of these visualization techniques is also useful for Descemet’s membrane endothelial keratoplasty through a hazy cornea with severe stromal bullous changes [14]. …”

13 Endoilluminator-Assisted Descemet Membrane Endothelial Keratoplasty and Endoilluminator-Assisted Pre-Descemet Endothelial Keratoplasty

“…We read with great interest the article by Kobayashi et al on the use of endoillumination probe-assisted Descemet membrane endothelial keratoplasty (DMEK) for bullous keratopathy secondary to argon-laser iridotomy. 1 We would like to bring to the author's notice that one of us (SJ) described the use of external endoillumination for DMEK, and the same was published under our names in 2014 as endoilluminator-assisted transcorneal illumination for DMEK, 2 with study patients included from January 2013. There are also numerous other references to this online.…”

“…First of all, I would like to apologize for overlooking a wonderful and important article concerning the use of an endoilluninator for Descemet membrane endothelial keratoplasty (DMEK) by Jacob et al published in 2014. 1 We have been using endoillumination to improve visualization during cataract surgery since 2003, 2 as cited in Jacob et al's article. 1 Therefore, it is quite natural for us to use this technique for DMEK as well as complicated partial thickness corneal transplant endothelial keratoplasty (DSAEK).…”

“…endoilluminator-assisted Descemet membrane endothelial keratoplasty and endoilluminatorassisted pre-Descemet endothelial keratoplasty Soosan Jacob 1,2 Amar Agarwal 1 Dhivya Ashok Kumar 1…”