Please use this identifier to cite or link to this item:
doi:10.22028/D291-41761
Title: | Surgical management of complicated Descemet's membrane detachment in corneas without prior endothelial keratoplasty |
Author(s): | Berger, Tim Seitz, Berthold Flockerzi, Elias Suffo, Shady Flockerzi, Fidelis A. Berger, Maximilian Szentmáry, Nóra Daas, Loay |
Language: | English |
Title: | Graefe's Archive for Clinical and Experimental Ophthalmology |
Volume: | 262 (2024) |
Issue: | 3 |
Pages: | 879-889 |
Publisher/Platform: | Springer Nature |
Year of Publication: | 2023 |
Free key words: | Cornea Keratoplasty Descemet’s membrane detachment Corneal ectasia |
DDC notations: | 610 Medicine and health |
Publikation type: | Journal Article |
Abstract: | Purpose To provide insights into morphologic and functional features of eyes with complicated Descemet's membrane detachment (DMD) and report clinical outcomes after surgical intervention. Methods Retrospective study of 18 eyes with complicated DMD between 2010 and 2022. Complicated DMD was defned if any of the following criteria applied: prior penetrating keratoplasty (PKP), corneal thinning, total DMD or persistent DMD after Air/Gas-Descemetopexy. Causes, surgical management, and clinical outcomes were analyzed. Scheimpfug tomography, anterior segment optical coherence tomography (AS-OCT) and histologic examination were performed to characterize corneas with DMD. Results Fourteen eyes with prior PKP developed spontaneous DMD after 24.2±12.9 years (range=18 months – 47 years, median=25.7 years). Complicated DMD without prior PKP was associated in three eyes after cataract surgery and in one eye after infectious keratitis. In cases with previous PKP, AS-OCT demonstrated rupture of Descemet’s membrane (DM) in fve eyes and spontaneous reattachment was found in four eyes within 8 weeks of initial diagnosis, with no rupture of DM in any of the cases. There was no rupture of DM in corneas without previous PKP. After prior keratoplasty, defnitive surgical treatment was repeat PKP in 13 eyes and Air/Gas-Descemetopexy in one eye. In corneas without prior keratoplasty, three eyes underwent PKP and one eye Air/Gas-Descemetopexy. Histological examination of two corneal explants revealed a severely thinned graft-host junction and a disrupted DM close to the graft-host junction. Visual acuity improved from 1.80±0.58 logMAR to 0.75±0.69 logMAR after prior PKP and from 1.45±0.65 logMAR to 0.85±1.13 logMAR without prior PKP. The postoperative course was uneventful in 16 of 18 eyes. Conclusion PKP is an efective treatment option for complicated DMD, especially in ectatic corneas, whereas Air/GasDescemetopexy or Descemet Membrane Endothelial Keratoplasty do not address the primary issue of the curvature anomaly. |
DOI of the first publication: | 10.1007/s00417-023-06231-w |
URL of the first publication: | https://link.springer.com/article/10.1007/s00417-023-06231-w |
Link to this record: | urn:nbn:de:bsz:291--ds-417616 hdl:20.500.11880/37372 http://dx.doi.org/10.22028/D291-41761 |
ISSN: | 1435-702X 0721-832X |
Date of registration: | 15-Mar-2024 |
Faculty: | M - Medizinische Fakultät |
Department: | M - Augenheilkunde M - Pathologie |
Professorship: | M - Prof. Dr. Berthold Seitz M - Prof. Dr. med. Nóra Szentmáry M - Keiner Professur zugeordnet |
Collections: | SciDok - Der Wissenschaftsserver der Universität des Saarlandes |
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s00417-023-06231-w.pdf | 1,35 MB | Adobe PDF | View/Open |
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