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Isolated descemetorhexis for anterior synechiolysis prior to endothelial keratoplasty – case report and technique

Authors Droutsas K, Andreanos K, Lazaridis A, Georgalas I, Kymionis G, Papaconstantinou D

Received 18 June 2017

Accepted for publication 24 August 2017

Published 19 October 2017 Volume 2017:13 Pages 1443—1447

DOI https://doi.org/10.2147/TCRM.S144258

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Garry Walsh


Konstantinos Droutsas,1,2 Konstantinos Andreanos,1 Apostolos Lazaridis,2 Ilias Georgalas,1 George Kymionis,1,3 Dimitris Papaconstantinou1

1First Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece; 2Ophthalmology Department, Philipps University Marburg, Marburg, Germany; 3Ophthalmology Department, Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland

Purpose: To describe the utilization of descemetorhexis for reformation of the anterior chamber in eyes with central iridocorneal synechiae before endothelial keratoplasty (EK).
Methods: A 71-year-old man with a history of trabeculectomy complicated by hypotony presented with bullous keratopathy in the presence of extensive iridocorneal synechiae and a flat anterior chamber. In order to proceed with EK, synechiolysis with the use of viscoelastic and scissors was attempted. Despite successful dissection of the peripheral strands, the pupillary margin of the iris remained attached to the endothelium. Therefore, descemetorhexis was performed to detach the Descemet membrane along with central synechiae and create sufficient space for safe EK at a later stage.
Results: Corneal clarity was restored by ultrathin Descemet stripping automated endothelial keratoplasty, leaving a fibrous membrane in the pupillary plane, which was excised 2 months later, allowing an improvement of best-corrected visual acuity to 0.5.
Conclusion: Isolated descemetorhexis was successfully employed to reform the anterior chamber and proceed with EK in a case of bullous keratopathy and resistant iridocorneal synechiae. This stepwise approach may be considered in similar cases in order to avoid a more invasive treatment, ie, penetrating keratoplasty and synechiolysis.

Keywords:
endothelial keratoplasty, iridocorneal synechiae, bullous keratopathy, descemetorhexis

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